Hyperbaric oxygen therapy in the treatment of COVID-19 — severe cases

From Wuhan China — promising results have just been published in a preliminary report by Dr. Zhong Yangling for the treatment of 5 COVID-19 patients (2 of which were critical and 3 were severe) with hyperbaric therapy at the Department of Hyperbaric Oxygen in Wuhan Yangtze River Shipping General Hospital.

In this report, hyperbaric oxygen was added to the current comprehensive treatments being performed at the hospital for COVID-19 affected patients, with a dose of 90-120 minutes at treatment pressures of 1.4 to 1.6 ATA. The results were very encouraging as these 5 patients received significant therapeutic benefits, including rapid relief of symptoms after the first session. The rationale for adding this procedure is to help combat the progressive hypoxemia (low blood oxygen levels) that COVID-19 can cause. Hyperbaric oxygen has the ability to add a substantial supply of extra oxygen into the bloodstream and therefore can help during these times of hypoxemia.

Hypoxemia is the key determinant to the deterioration of patients seen with COVID-19. The virus attacks the lungs and causes inflammation and the body has a difficult time getting enough oxygen transferred from the lungs into the body. This progressive hypoxemia leads to an increase in mortality rates as patients can become critically ill. At this time, they are typically in complete reliance on ventilators to help restore oxygen levels, to keep them alive, while the body fights the virus and repairs the lung damage.

The advantage of hyperbaric oxygen for the treatment of progressive hypoxemia is that the higher pressure environment allows greater levels of oxygen to pass through the thickened and inflamed lung tissue into the bloodstream; thereby directly treating the hypoxemia. Add to this, the greater solubility of oxygen in the blood (in hyperbaric conditions) and it’s now easy to see why all 5 patients reported dramatic relief of their symptoms — Dr. Zhong reported that after the first session of hyperbaric oxygen, symptoms such as dyspnea (shortness of breath) and chest pain were reduced. After the second session, the respiratory rate decreased gradually and the shortness of breath (after movement) was relieved slowly. To correlate with these subjective results, Dr. Zhong was able to objectively chart a significant upward trend of oxygen levels, day by day. In addition, lung inflammation was re-evaluated through CT scan, and all 5 patients significantly improved.

It should be noted, that hyperbaric oxygen is not a treatment for the COVID-19 virus and this report should NOT lead people to look for hyperbaric chambers for treating the virus, particularly within private centers that are not equipped for treating infectious diseases. However, this is a very important paper outlining the potential clinical role that hyperbaric therapy can play in the symptomatic relief of hypoxemia that is seen in the COVID-19 affected population. Hopefully, this will lead the medical community to take a much harder look at integrating hyperbaric therapy and utilizing its key physiological benefits (ie, reducing hypoxia). In turn, this could lead to a much larger demand for the use of hyperbaric chambers in hospitals and infectious disease centers to coexist as a supportive therapy, during these critical stages. Deploying hyperbaric chambers in this manner could offer major lifeline support to patients, while aggressive medical treatments are being administered in the hospital setting. This applies to both current hospital-type chambers and portable hyperbaric chambers as these chambers can be performed in the open area of the hospital.

Hospital chambers — According to Dr. Zhong, these chambers can help “improve the treatment efficiency, reduce the medical pressure and the risk of infection, and decrease the mortality rate of critical patients”. With the limited supply of ventilators, hyperbaric chambers can offer valuable relief. Hyperbaric Oxygen Department of Wuhan Changjiang Shipping General Hospital has established complete infection control procedures and measures for the hyperbaric treatment of patients with coronavirus. If followed, this could lead to a widespread movement of hyperbaric chambers to help in areas where the local demand is too great from community infection. In Wuhan, Huoshenshan hospitals are not equipped with hyperbaric chambers so construction of a new hyperbaric oxygen chamber system started at Huoshenshan Hospital and is being installed and commissioned for use within 15 days!

Portable chambers — These chambers are typically operated at lower pressures of 1.3 ATA and can have physiological benefits in reducing hypoxemia. Of note, Dr. Zhong also tested 1.2 to 1.4 ATA and found that the oxygen levels were still kept in a high level and this was even with ambient air application. Again, as a supportive therapy, this could be very valuable for helping to maintain oxygen levels. Here in the United States, these types of chambers have been making steady growth in the hyperbaric industry (over the past 20 years) and fueled lately by high-profile athletes promoting its benefits. As this industry grows, many private hyperbaric centers are now writing prescriptions for patients for home use. This may help during times of isolation and the early infection period when patients are told to stay at home until symptoms become severe and hypoxemia begins to take its toll.

To summarize, this publication by Dr. Zhong should encourage us to look into hyperbaric medicine in a new way, when it comes to severe respiratory diseases caused by a coronavirus. Since this study, Dr. Zhong has now treated a total of 35 COVID-19 cases. As this pandemic continues, we do not know how much of the public will be affected and the extra load that will impact our medical system. What we do know is that this virus primarily targets the lung tissue, causing severe inflammation and hypoxemia. Hyperbaric oxygen may offer a valuable therapeutic delivery of oxygenation during times of hypoxemia. More research should be looked into this.

Disclaimer — is very important that this article is not construed as an article that promotes treating COVID-19 with hyperbaric therapy. Anyone who has been diagnosed with COVID-19 or suspected of having this infection should follow the CDC guidelines (and not seek treatments in a hyperbaric chamber as an alternative). This is purely educational material on the new preliminary report published from Wuhan China <view report>

1.6 vs 2.2 ATA of hyperbaric oxygen for traumatic brain injuries?

The benefits of hyperbaric oxygen therapy for dramatic brain injury (TBI) has been confirmed by many studies. Now the question is “what is the best dose (ie, pressure protocol) to achieve the optimal benefits.

As new research becomes available, it appears that the lower the pressure, the stronger the benefits. This study confirms the recent data, by showing that 1.6 ATA hyperbaric intervention was superior to 2.2ATA for neurological impairment and the restoration of symptoms following TBI.

Researchers in this study suggested that “for the first time that 1.6 ATA HBO has an important protective role in inhibiting both the cytotoxic and the pro-inflammatory actions of histones in the early stage of secondary brain injury”. <view study>

Hyperbaric Oxygen therapy initiates Bone Healing

This study clearly demonstrated that it only took 5 days to significantly enhance bone growth, reduce inflammation, and accelerate bone healing, with positive results in bone new bone formation <view study>

Hyperbaric oxygen expected to be a new breakthrough for Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and joint damage. Synovial hypoxia (low oxygen) is a specific feature of RA and plays an important role in the formation and progression of this disease.

“Hypoxia induces angiogenesis, inflammation, apoptosis, cartilage erosion, abnormal energy metabolism and oxidative damage” Hyperbaric oxygen therapy (HBOT) can reverse hypoxic conditions throughout the body and therefore can help effectively halt the pathogenesis of RA.

In this study, the animal model of RA was evaluated with hyperbaric oxygen therapy; whereby, male mice received a total of 10 daily hyperbaric sessions at 2.4 ATA (90 minutes of pure oxygen and two 5 minute air breaks). This group of mice that received HBOT had a significant reduction in the mouse model of arthritis, along with a reduction in disease-progressive inflammatory markers. After evaluating all the data collected from this study, the researchers concluded that a 10-day course of hyperbaric therapy in 12 days can be “an alternative therapy that is considered successful in reducing morbidity and mortality of RA patients” <view study>

In addition to the study above, a new pilot study published in the journal of Clinical Rheumatology on September 16, 2020, also found Hyperbaric oxygen therapy to be effective for joint pain in patients with RA <view this study>