References
Hyperbaric oxygen therapy in preventing mechanical ventilation in covid-19 patients: a retrospective case series:
Abstract
Objective:
A pandemic afflicts the entire world. The highly contagious SARS-CoV-2 virus originated in Wuhan, China in late 2019 and rapidly spread across the entire globe. According to the World Health Organization (WHO), the novel Coronavirus (COVID-19)has infected more than two million people worldwide, causing over 160,000 deaths. Patients with COVID-19 disease present with a wide array of symptoms, rang=spiratory syndrome (SARS) requiring mechanical ventilation. Once intubated, mortality increases exponentially. A number of pharmacologic regimens, including hydroxychloroquine-azithromycin, antiviral therapy (eg, remdesevir), and anti-IL-6 agents (e.g., toclizumab), have been highlighted by investigators over the course of the pandemic, based on the therapy's potential to interrupt the viral life-cycle of SARS-CoV-2 or preventing cytokine storm. At present, there have been no conclusive series of reproducible randomised clinical trials demonstrating the efficacy of any one drug or therapy for COVID-19.
Cases:
COVID-19 positive patients (n=5) at a single institution received hyperbaric oxygen therapy (HBOT) between 13 and 20 April 2020. All the patients had tachypnoea and low oxygen saturation despite receiving high FiO2. HBOT was added to prevent the need for mechanical ventilation. A standard dive profile of 2.0ATA for 90 minutes was employed. Patients received between one and six treatments in one of two dedicated monoplace hyperbaric chambers.
Results:
All the patients recovered without the need for mechanical ventilation. Following HBOT, oxygen saturation increased, tachypnoea resolved and inflammatory markers fell. At the time of writing, three of the five patients have been discharged from the hospital and two remain in stable condition.
Conclusion:
This small sample of patients exhibited dramatic improvement with HBOT. Most importantly, HBOT potentially prevented the need for mechanical ventilation. Larger studies are likely to define the role of HBOT in the treatment of this novel disease.
The highly contagious SARS-CoV-2 virus, thought to have originated in Wuhan, China, has infected more than two million people at the time of writing.1 In the US alone, the death toll exceeds 40,000 people.2 The pathogenic SARS-CoV-2, a single-stranded, RNA-enveloped virus, causes respiratory disease in humans.3 The clinical presentation varies from asymptomatic SARS-CoV-2 positive patients to life threatening cardiac and pulmonary complications. An article in the Journal of the American Medican Association (JAMA) in February 2020 from Wuhan, China reported that 26% of infected patients required intensive care with a mortality rate of 4.3%.4 Older people and patients with multiple comorbidities have an increased risk of severe acute respiratory syndrome (SARS) and death. In addition, an elevated D-dimer (a product of fibrinogen degradation that indicates a prothrombotic state) on admission corresponds with a poor outcome.5,6 Finally, once the patient requires mechanical ventilation, the risk of mortality rises sharply.7
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