The International Hyperbaric Medicine and Research Association (Ihmera) has investigated the potential role of Hyperbaric Oxygen Therapy (HBOT) in the care of patients with COVID-19. As a result, it delivered a series of documents and procedures that can be applied by the health authorities according to their requirements.
The symptoms of COVID-19 disease are becoming clearer. Despite this, governments have faced problems in eradicating the virus due to the saturation of health services. The most severe patients require ventilatory support devices that are insufficient for high demand. This has impeded proper medical care in some cases.
The Ihmera states that hyperbaric oxygen therapy could play a key role in the care of infected patients, according to its severity, decompressing the health service and offering a highly efficient, low-cost and easily applicable alternative, especially when there is a need to face the expected spike in infections.
COVID-19: Hypoxia, inflammation and immune response
The Ihmera maintains that, given the emergency of patients with COVID-19 and the limited resources of extracorporeal oxygenation, Hyperbaric Oxygen Therapy could be used in the treatment of infected patients with hypoxemic failure who do not present pulmonary contraindications. Hyperbaric oxygen can help to recover the acute hypoxic phase of the disease, decrease the inflammatory phase, promote recovery and perhaps speed up the times for the release of beds required to assist these patients during the pandemic. Additional studies are needed.
Summary of Dr. Zhong Yianling’s article on severe cases of COVID-19 and Hyperbaric Oxygen Therapy
In the midst of the Coronavirus pandemic and in the debate about whether hyperbaric oxygen can reverse pulmonary hypoxia (cause of death in patients with COVID-19), 5 severe cases of COVID-19 were treated in Wuhan with Hyperbaric Oxygenation Treatment ( TOHB) to 1.6 ATA in sessions of 120 minutes. These patients were attended by Dr. Zhong Yianling.
Dr. Yianling promotes the use of HBOT as a treatment for critically ill patients with COVID-19 since it would generate greater efficiency in treatment, reduce pressure on health personnel and the risk of infection, and decrease the mortality rate of patients critics.
A case report on the use of Hyperbaric Oxygen Therapy in the treatment of severe cases of COVID-19
Clinical reports and anatomical findings show that progressive hypoxemia is the cause of the deterioration in patients with COVID-19. Five severe cases of COVID-19 were treated in Wuhan and Hyperbaric Oxygenation Treatment was shown to be an excellent therapy for these patients.
Dr. Yianling concludes that the improvement in the pathophysiological mechanisms obtained with hyperbaric oxygenation therapy (HBOT) is greater than that obtained by breathing by mechanical ventilation techniques.
COVID: Hemoglobin and Hypoxia
A study by Wenzhong, Liu, and Hualan, Li concludes that the direct action of the Coronavirus on porphyrin interferes with its metabolism and oxygen transport, contributing to favoring hypoxemia and systemic hypoxia.
If the destruction of hemoglobin occurs, which is the main oxygen transport route in normobaric oxygenation, Hyperbaric Oxygen Therapy could contribute by supplying diluted oxygen in plasma independently of hemoglobin. This contribution is based on the dissolution of plasma oxygen with the hyperbaria by a different and more effective mechanism than respirators (dependent on hemoglobin, which is diminished and destroyed by infection with the new Coronavirus).
COVID-19: attacks the 1-Beta chain of hemoglobin and captures porphyrin to inhibit the human heme metabolism
Previous studies revealed the abnormal phenomenon of hemoglobin-related biochemistry in patients with COVID-19. The patients presented low levels of hemoglobin and neutrophils in most cases, and the significant elevation of serum ferritin, erythrocyte sedimentation rate, C-reactive protein, albumin, and lactate dehydrogenase. These results imply a decrease in hemoglobin but an increase in the heme group, which would lead to harmful iron deposits, causing inflammation, the elevation of C-reactive protein and albumin.
A study by Wenzhong et al used bioinformatics programs to evaluate conserved domains, homologous sequences, and molecular coupling, and thus, to analyze the biological roles of the viral proteins of the new coronavirus and its relationship with the structure of the heme group of hemoglobin.
Recommendations and protocol for Hyperbaric Oxygenation Treatment in COVID-19
A group of Ihmera specialists developed a protocol for the use of the Hyperbaric Chamber in patients infected with COVID-19. These recommendations were designed to be applied in the different Argentine provinces with the available equipment.
Clinical Trial Hyperbaric Oxygen as an Adjuvant Treatment for Patients With Covid-19 Severe Hypoxemia
The severity of COVID-19 is related to the level of hypoxemia, respiratory failure, how long it lasts and how refractory it is at increasing concentrations of inspired oxygen. The inability to perform hematosis due to edema that occurs from acute inflammation could be attenuated by the administration of hyperbaric oxygen (HBO). Recently, it has been reported benefits in this matter in patients with SARS-CoV-2 hypoxemic pneumonia in China; where the administration of repeated HBO sessions decreased the need for mechanical ventilation (MV) in patients admitted to the Intensive Care Unit due to COVID-19.
In the current context of the pandemic by COVID-19 and worldwide reports of mortality associated with severe cases of respiratory failure, it is essential to propose therapeutical strategies to limit or decrease respiratory compromise of severe stages by COVID-19. That is why, it is proposed to carry out this research to assess whether HBO treatment can improve the evolution of patients with COVID-19 severe hypoxemia.