Efficacy and safety of hyperbaric oxygen treatment in SARS-COV-2 (COVID-19) pneumonia: a systematic review

Effectiveness of Hyperbaric Oxygen Therapy in SARS-CoV-2 Pneumonia: The Primary Results of a Randomised Clinical Trial

Mortality in COVID-19 is mainly associated with respiratory failure, cytokine storm, and macrophage activation. Oxygenation and anti-inflammatory effects of Hyperbaric Oxygen Therapy (HBOT) suggest that it is a promising adjunct treatment for COVID-19. Repeated sessions of HBO with standard COVID-19 therapy were used to reduce the inflammation and increase oxygenation. We evaluated the safety and efficacy of HBOT in avoiding the replacement ventilation and/or ECMO and its effect on the inflammatory process. Twenty-eight moderate-to-severe COVID-19 patients were randomized into control or HBOT group. HBOT patients participated in 5 hyperbaric sessions (60 min). Before and after each session blood gas levels and vital parameters were monitored. Blood samples were collected for extended biochemical tests, blood morphology and immunological assays. There were 3 deaths in the control, no deaths in the HBOT group. No adverse events leading to discontinuation of HBOT were observed and patients receiving HBOT required lower oxygen delivery. We observed decrease in CRP, ferritin and LDH and increase in CD3 in HBOT group compared to control. This study confirmed the feasibility and safety of HBOT in patients with COVID-19 and indicated HBOT can lead to alleviation of inflammation and partial restoration of T cell responses.

Efficacy and safety of hyperbaric oxygen treatment to treat COVID-19 pneumonia: a living systematic review update

INTRODUCTION

As the COVID-19 pandemic evolves, new effective treatment options are essential for reducing morbidity and mortality as well as the strain placed on the healthcare system. Since publication of our initial review on hyperbaric oxygen treatment (HBOT) for hypoxaemic COVID-19 patients, interest in HBOT for COVID-19 has grown and additional studies have been published.

METHODS

For this living systematic review update the previously published search strategy (excluding Google Scholar) was adopted with an extension from 01 February 2021 to 01 April 2022. Study inclusion criteria, data extraction, risk of bias estimation and dispute resolution methods were repeated.

RESULTS

Two new studies enrolling 127 patients were included in this update, taking the total to eight studies with 224 patients. Both new studies were randomised controlled trials, one at moderate and one at high risk of bias. Across these eight studies, 114 patients were treated with HBOT. All reported improved clinical outcomes without observation of any serious adverse events. Meta-analysis remained unjustified given the high heterogeneity between studies and incomplete reporting.

CONCLUSIONS

This updated living systematic review provides further evidence on the safety and effectiveness of HBOT to treat acute hypoxaemic COVID-19 patients.

Prevention and Treatment of Life-Threatening COVID-19 May Be Possible with Oxygen Treatment

Most SARS CoV-2 infections probably occur unnoticed or cause only cause a mild common cold that does not require medical intervention. A significant proportion of more severe cases is characterized by early neurological symptoms such as headache, fatigue, and impaired consciousness, including respiratory distress. These symptoms suggest hypoxia, specifically affecting the brain. The condition is best explained by primary replication of the virus in the nasal respiratory and/or the olfactory epithelia, followed by an invasion of the virus into the central nervous system, including the respiratory centers, either along a transneural route, through disruption of the blood-brain barrier, or both. In patients, presenting with early dyspnea, the primary goal of therapy should be the reversal of brain hypoxia as efficiently as possible. The first approach should be intermittent treatment with 100% oxygen using a tight oronasal mask or a hood. If this does not help within a few hours, an enclosure is needed to increase the ambient pressure. This management approach is well established in the hypoxia-related diseases in diving and aerospace medicine and preserves the patient's spontaneous breathing. Preliminary research evidence indicates that even a small elevation of the ambient pressure might be lifesaving. Other neurological symptoms, presenting particularly in long COVID-19, suggest imbalance of the autonomous nervous system, i.e., dysautonomia. These patients could benefit from vagal nerve stimulation.

Rehabilitation of severe neurological complications post SARS-CoV-2 infection

Medical rehabilitation is a multi-professional / interdisciplinary process aimed at enhancing and restoring functional ability (activity and participation) and quality of life to people with im-pairments or disabilities. Rehabilitation is applied throughout the continuum of care. COVID-19 patients may develop a myriad of acute medical problems (linked to the virus per se, or as con-sequences of the invasive procedures), which can cause acute, post-acute and long-term conse-quences requiring rehabilitation. Information about short and long-term sequelae of COVID-19 indicate an increasing need for rehabilitation. The paper is focused on two main aspects: rehabil-itation of the severe neurological disabilities that occurred during the acute phase and continu-ing in the chronic phase (i.e., different neurological sensory-motor and cognitive deficits sec-ondary to stroke, encephalitis, seizures, encephalopathies). The other main issue is generated by the disruption of regular rehabilitation in people with neurological disabilities and chronic dis-eases (people living with sequels after stroke, Parkinson's disease, multiple sclerosis) due to quarantine, social isolation, movement restriction, and other healthcare systems ’disruptions. Methods Internet literature search (Lit Covid and PubMed) using the following keywords (Covid-19, Coronavirus, neurological complications, rehabilitation). During 2020-2021 were published 88 papers (in 2020 = 54, and in 2021= 54), with 21 reviewes (2020 = 15; 2021 = 8), and 2 systematic reviews, refearing neuroreabilitation in Covid-19 subacutre and long-term cas-es. Discussion REH-COVER Cochrane Rehabilitation WHO initiative (“Rapid Living Systematic Reviews Second Edition, called 2020”), contains the main cornerstones for a tailored rehabilita-tion programme, the best (current) available rehabilitation evidence on recovery interventions, for the patients living with sequelae of COVID-19. Conclusions More than two years since the outbreak of the COVID-19 pandemic, it is obvious that rehabilitation services play a crucial role in post-COVID recovery trajectories. A further achievement of research and evidence focussed on the clinical management, comprehensive treatments, and efficacy need to be targeted on short and long-term (neuro)-rehabilitation service models of care, for COVID-19 survivors. Keywords: Covid-19, rehabilitation, neurological disabilities, SARS-CoV-2

Hyperbaric Oxygen Treatment-From Mechanisms to Cognitive Improvement

Hyperbaric oxygen treatment (HBOT)—the medical use of oxygen at environmental pressure greater than one atmosphere absolute—is a very effective therapy for several approved clinical situations, such as carbon monoxide intoxication, incurable diabetes or radiation-injury wounds, and smoke inhalation. In recent years, it has also been used to improve cognition, neuro-wellness, and quality of life following brain trauma and stroke. This opens new avenues for the elderly, including the treatment of neurological and neurodegenerative diseases and improvement of cognition and brain metabolism in cases of mild cognitive impairment. Alongside its integration into clinics, basic research studies have elucidated HBOT’s mechanisms of action and its effects on cellular processes, transcription factors, mitochondrial function, oxidative stress, and inflammation. Therefore, HBOT is becoming a major player in 21st century research and clinical treatments. The following review will discuss the basic mechanisms of HBOT, and its effects on cellular processes, cognition, and brain disorders.

Hyperbaric Oxygen Therapy in Covid-19 Treatment: Efficacy and Safety

Introduction: New effective treatments are sought to eliminate COVID-19-related hypoxia. Hyperbaric oxygen therapy is an effective method in the treatment of many diseases accompanied by hypoxia.

Aim: The aim of this study was to analyse the literature on the use of hyperbaric oxygen in the treatment of COVID-19 and to evaluate the effectiveness and safety of this method.

Materials and methods: Medical databases (Medline and PBL) and websites were reviewed using the terms hyperbaric oxygen and COVID-19. 25 works were qualified for the analysis.

Conclusions: The analysed literature shows that hyperbaric oxygen therapy is an effective and safe method of treating patients with COVID-19. Due to the limited amount of scientific evidence assessing the use of HBOT in COVID-19, there is a need for further research to confirm the effectiveness and safety of this method.