Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls

2020 ◽  
pp. 405-413 ◽  
Author(s):  
Scott A. Gorenstein ◽  
◽  
Michael L. Castellano ◽  
Eric S. Slone ◽  
Brian Gillette ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Distress ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Secondary Outcome ◽  
Inpatient Mortality ◽  
Oxygen Requirement ◽  
Subdistribution Hazard ◽  
Artery Disease

Objective: Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress. Methods: This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation. Results: We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046). Conclusions: Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multi-center randomized control trial.

Hyperbaric Oxygen Therapy and Its Suitability as an Adjuvant for Treatment of Covid-19 Patients: A Review

2021 ◽  
Vol 12 (4) ◽  
pp. 2548-2556
Author(s):  
Sameera Dawar ◽  
Meena Jain
Keyword(s):  
Mechanical Ventilation ◽  
Oxygen Saturation ◽  
Hyperbaric Oxygen ◽  
Basic Principle ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Delivery ◽  
Atmospheric Pressure ◽  
Oxygen Therapy ◽  
Tissue Oxygenation ◽  
The Body

The outbreak of the SARS CoV2 ' pandemic' is believed to have originated in Wuhan in 2019 as a spread from bats to humans. It is a highly communicable infection-causing rapid human to human transmission of the virus by virtue of its infectious and nature. The virus has affected millions of people worldwide, with numbers still rising with each passing day. Depleting oxygen saturation levels is amongst the prime concerns in the majority of infected patients. Nasal prongs, face masks, mechanical ventilation and membrane (ECMO) are the commonly used modes of oxygen delivery in such patients. These methods though mostly successful, at times fail to restore the depleting oxygen levels to normal. oxygen therapy (HBOT) involves the administration of 100% O2 in a special chamber whose pressure is maintained at a level greater than 1 ATP. The main purpose for raising the pressure within the chamber is that as the atmospheric pressure increases, the saturation levels of oxygen in the blood also increase, which eventually result in increased overall tissue oxygenation. This article provides a systematic and wholesome review on the basic principle of oxygen therapy, its effects on the body at a microscopic and macroscopic level, its various uses and its suitability as an for the treatment of select COVID-19 infected patients.

Hyperbaric oxygen therapy in preventing mechanical ventilation in COVID-19 patients: a retrospective case series

2020 ◽  
Vol 29 (Sup5a) ◽  
pp. S4-S8 ◽  
Author(s):  
Kerry Thibodeaux ◽  
Marcus Speyrer ◽  
Amer Raza ◽  
Raphael Yaakov ◽  
Thomas E Serena
Keyword(s):  
Mechanical Ventilation ◽  
Oxygen Saturation ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Small Sample ◽  
World Health ◽  
Cardiac Complications ◽  
Dramatic Improvement ◽  
Increased Risk

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, ranging from mild flu-like complaints to life threatening pulmonary and cardiac complications. Older people and patients with underlying disease have an increased risk of developing severe acute respiratory 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.

scholarly journals Magnitude and Clinical Predictors of Blood Pressure Changes in Patients Undergoing Hyperbaric Oxygen Therapy: A Retrospective Study

2020 ◽  
Vol 17 (20) ◽  
pp. 7586
Author(s):  
Simone Schiavo ◽  
Carine Djaiani ◽  
Julian DeBacker ◽  
Lisa Albertini ◽  
Daniel Santa Mina ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Secondary Outcome ◽  
Clinical Predictors ◽  
Arterial Blood ◽  
Before And After ◽  
History Of ◽  
Pressure Changes

Hyperbaric oxygen therapy (HBOT) is widely used to treat several pathologies. The hemodynamic changes during HBOT, particularly the magnitude of arterial blood pressure (ABP) increase, are not completely understood. No clinical predictors for HBOT-induced ABP increase have been described. The purpose of this study was to quantify ABP changes in patients undergoing HBOT and to examine their predictors. This retrospective longitudinal cohort study examined 3291 elective HBOT sessions. Non-invasive ABP was recorded before and after each session. The primary outcome was to quantify the HBOT-induced ABP rise. The secondary outcome was to determine the ABP-rise predictors among demographic and clinical variables. Overall, ABP increased significantly after HBOT; this finding was more evident in the hypertensive subgroup compared to the normotensive one (+6 vs. +16.2 mmHg). Clinical predictors of significant post-HBOT ABP change were history of hypertension and pre-session baseline ABP classification. This study demonstrates an absolute HBOT-induced ABP rise. This change is clinically relevant in patients with history of hypertension. A higher baseline ABP seems a risk factor for clinically relevant ABP change. Pre-session ABP should be used clinically as an indicator for strict ABP monitoring during HBOT; future studies are recommended to explore the ABP optimization before starting an HBO treatment.

scholarly journals Hyperbaric Oxygen Therapy For Hospitalized COVID-19 Patients With Moderate To Severe Hypoxia

2021 ◽  
Author(s):  
Deepa Jansen ◽  
Daniel R. Dickstein ◽  
Kasandra Erazo ◽  
Ellen Stacom ◽  
David C. Lee ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Randomized Clinical Trials ◽  
Patient Characteristics ◽  
Inpatient Mortality ◽  
Exact Test ◽  
Therapeutic Benefits ◽  
Receive Treatment

Abstract Introduction: Few treatments have demonstrated mortality benefit among hospitalized hypoxic COVID-19 patients except for steroids. We evaluated the use of hyperbaric oxygen therapy (HBOT) as a therapeutic intervention among hospitalized patients with a high oxygen requirement.Methods: We extracted data on patients with COVID-19 hypoxia who required at least 6 L/min oxygen supplementation, and were eligible for off-label HBOT from October 2020 to February 2021. We compared patient characteristics and used Fisher’s exact test and a survival analysis to assess the primary endpoint of inpatient death.Results: We offered HBOT to 36 patients, of which 24 received treatment and 12 did not receive treatment. Patients who did not receive treatment were significantly older (P < 0.01) and had worse baseline hypoxia (P = 0.06). Three of the 24 (13%) patients who received treatment died compared to 6 of 12 (50%) patients who did not receive treatment (RR ratio: 0.25, P = 0.04, 95% CI: 0.08 to 0.83). In the survival analysis, there was a statistically significant reduction in inpatient mortality in the treatment group (HR: 0.19, P = 0.02, 95% CI: 0.05-0.74). However, after adjusting for age and baseline hypoxia, there was no difference in inpatient mortality (hazard ratio: 0.48, P = 0.42, 95% CI: 0.08-2.86).Conclusions: The survival benefit of HBOT observed in our unadjusted analysis suggests the need to further study therapeutic benefits of HBOT in treating COVID-19 hypoxia through randomized clinical trials.

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