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

Objective: A pandemic afflicts the entire world. The highly contagiousSARS-CoV-2 virus originated in Wuhan, China in late 2019 and rapidlyspread across the entire globe. According to the World Health Organization (WHO), the novel Coronavirus (COVID-19)has infectedmore 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 andcardiac complications. Older people and patients with underlyingdisease have an increased risk of developing severe acute respiratorysyndrome (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 beenhighlighted by investigators over the course of the pandemic, based onthe therapy’s potential to interrupt the viral life-cycle of SARS-CoV-2 orpreventing cytokine storm. At present, there have been no conclusiveseries of reproducible randomised clinical trials demonstrating theefficacy 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.

Categories: COVID and Post-Covid