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Hyperbaric Oxygen Therapy in treatment of COVID-19 severe cases

Clinical reports and pathologic anatomic findings shown, progressive hypoxemia is the main cause of deterioration in patients with COVID-19.”The mortality rate of critical patients in WuHan is close to 60%, and we are trying to solve the problem of hypoxia,” Zhong Nanshan said on 27th Feb. HBOT is the strongest non-invasive oxygen therapy. In the early stage, 5 cases of severe and critical patients with COVID-19 a were clinically treated, which proved that the long-term excellent clinical effect of using HBOT in treating hypoxia was also applicable to COVID-19 patients. The effect of HBOT is better than breathing atmospheric high flow oxygen and mechanical ventilation techniques. It is suggested that promote HBOT as an oxygen therapy treatment for critically ill patients with COVID-19, which is expected to significantly improve the treatment efficiency, reduce the medical pressure and the risk of infection, and decrease the mortality rate of critical patients. It has practical significance for further accelerating the overall victory of this epidemic, achieving the most effective treatment and realizing infection prevention control.

COVID-19

Evaluation of the effectiveness of HBOT in oxygen therapy for critical patients with COVID-19.

5 critical patients showed consistent response to HBOT oxygen therapy
Zhong Yangling, the director of the Department of Hyperbaric Oxygen in Wuhan Yangtze River Shipping General Hospital, successfully carried out HBOT treatment in 5 patients with COVID-19 (2 critical and 3 severe), which got significant results. Case reports of the first patient have been published. 5 cases clinical analysis data shown: 

hyperbaric-oxygen-therapy

Treatment effect of progressive hypoxemia in severe patients:

– Rapid relief of hypoxic symptoms.

– Rapid correction of hypoxemia.

Comprehensive therapeutic effect of HBOT oxygen therapy on severe patients:

General condition reversal.

Clinical objective indicators improved.

Improved lung pathology.

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Hyperbaric Application to COVID-19 Pulmonary Infection

In the midst of the coronavirus epidemic/pandemic it bears remembering the application of hyperbaric oxygen therapy to the last major pandemic that impacted the United States in 1918, the Spanish Flu Pandemic.  Death was primarily by pulmonary infection and its attendant hypoxemia and respiratory failure.  The first application of hyperbaric medicine to a Spanish Flu victim was likely also the first application to a human being in the United States.  In 1918 Dr. Orval Cunningham of Kansas City was brought a dying friend of a fellow physician.  The patient was moribund and blue.  Before Cunningham could perform his planned animal experiments he was asked to treat this dying patient. With just a one-hour treatment with compressed air at 1.68 atmospheres absolute the patient experienced improvement.  Combined with additional hyperbaric treatments over the next 3 days this patient’s life was saved.  Others followed.

Coronavirus-Hyperbaric-Oxygen

Today’s coronavirus’ mortality is due to pulmonary infection and respiratory failure. While there are differences between the Spanish Flu and coronavirus the primary pathology is in the lungs, the first organ of contact with hyperbaric therapy beyond the skin.  The ability of hyperbaric oxygen to penetrate inflammatory pulmonary secretions allows adequate oxygen to reach the blood while inhibiting the inflammatory process. Applied correctly, hyperbaric therapy may have utility in coronavirus patients similar to its life-saving history with the Spanish Flu.

 

 

Update 3/17/2020:

Potential of HBOT Treatment for Coronavirus is Supported by New Evidence. However, Be Cautious of Opportunists!

Two new pieces of evidence have surfaced supporting Dr Harch’s original proposal of 3/3/2020 to consider HBOT for the treatment of coronavirus infection.

Today, the publication of a retrospective analysis of lung CT scans on 121 patients infected with coronavirus in four Chinese provinces was announced. The CT scans showed progressive air space disease that radiologically depicted the diffusion barrier to oxygen that Dr. Harch suggested was similar to the lung pathology in Spanish Flu victims of 1918.

Simultaneously, Dr. Harch’s research assistant found evidence of successful treatment of a severe case of coronavirus infection in Wuhan, China. The patient was treated through the critical period with a similar number of daily hyperbaric treatments that Dr. Orval Cunningham used on his Spanish Flu cases in 1918. This Chinese patient managed to successfully traverse the critically ill period and was no longer in jeopardy.

This successful treatment, however, is a double-edged sword. Infection transmission is facilitated in hyperbaric chamber environments. Look no further than saturation diving conditions, where strict sanitation and infection control measures are industry standards. Coronavirus-infected patients should only be treated by medical professionals who are trained, experienced, and equipped to provide HBOT treatment under strict infection mitigated conditions.

Beware of clinics and opportunists advertising to “boost immunity” or treat coronavirus patients in portable chambers or other chambers in freestanding centers without qualified healthcare professionals trained, experienced and equipped to practice with strict infection control. This type of opportunism has beset the hyperbaric medicine field for centuries. Opportunists like this are responsible for the disparagement of hyperbaric therapy that has overshadowed the science and clinical wonder of this therapy. Hyperbaric clinics that are not equipped to treat coronavirus will act as vectors to amplify disease dissemination. Beware!

source:

Dr. Paul Harch

Hyperbaric Oxygen Therapy for New Coronavirus Pneumonia

From the pathophysiological characteristics of new coronavirus pneumonia (NCP) and the effect mechanism analysis of hyperbaric oxygen therapy (HBOT), HBOT may have a good effect in the treatment of NCP persistent hypoxemia. In view of the NCP guidelines (National Health Commission) and various clinical reports, the fact that the oxygen therapy method of NCP patients is continuously upgraded, and the beneficial attempts of the Department of Hyperbaric Oxygen of Changjiang Shipping General Hospital are optimistic, it is recommended to include HBOT in the guidelines as NCP One of the means of clinical treatment, for first-line doctors to choose.

COVID-19

Pathological characteristics of NCP

 

For example, the National Health Commission issued a report on the treatment of pneumonia caused by new crown virus infection (fifth edition, hereinafter referred to as the guideline) and interviews with multiple expert treatment teams. Diffuse, progressive lung tissue inflammation, persistent progressive hypoxemia, multiple organ failure (especially liver and heart function) failure, and inflammatory cytokine waterfall (cytokine storm).

Deficiencies in atmospheric oxygen therapy

Various reports show that the oxygen therapy measures in NCP treatment have been continuously upgraded from nasal catheters, non-invasive ventilation to invasive mechanical ventilation, and even ECMO. This indicates that there may be treatment needs that cannot be met by oxygen at atmospheric pressure. The underlying reasons may be:

1. Severe gas diffusion disorder and ventilation / blood flow ratio caused by interstitial lesions of the lung tissue are important reasons for the inability to correct hypoxemia with the support of ventilation.

2. The systemic metabolic rate continues to increase due to inflammation. The amount of oxygen trioxide transported by hemoglobin transport cannot meet the body’s metabolic needs. The body is in a “chronic” hypoxic state of systemic tissues, especially the liver and heart tissues’ dependence on oxygen. Sex is more obvious. Therefore, in some patients, ECMO may still be insufficient to correct hypoxia in deep tissues and vital organs.

3. The cumulative effect of “oxygen debt” may be one of the important triggers of the cytokine storm.

Advantages of HBOT

HBOT is based on the laws of gas physics related to pressure. The differences and advantages of HBOT from atmospheric oxygen absorption are:

1. Improve the diffusion efficiency of oxygen, overcome the gas diffusion obstacle caused by interstitial lesions, as long as there is a certain amount of ventilation, you can obtain better gas exchange efficiency than normal people when breathing.

2. The physically dissolved oxygen content in the blood is much larger than the combined hemoglobin transport capacity. It does not depend on the oxygen transport function of hemoglobin, and can meet the oxygen consumption of the body’s metabolic state.

3. The diffusion distance of oxygen is increased, and the aerobic metabolism needs of deep tissues and hypoperfusion tissues are solved.

4. HBOT can complete the repayment of “oxygen debt” in a short period of time, provide aerobic metabolism windows for deep hypoxic tissues and important organs, and play a good role in supporting treatment.

5. A large number of studies have confirmed the effect of HBOT on immune cells and inflammation. The therapeutic effect of hyperbaric oxygen in acute high altitude pulmonary edema has been confirmed by a lot of literature. Intermittent HBOT can reduce the accumulation of “oxygen debt” load, or it can play a role in delaying and blocking cytokine storms.

Limitations of HBOT

1. HBOT requires special equipment, complex structure, and limited number of one-time treatments.

2. Although there are systematic hygienic management regulations (cabin sterilization, etc.), in view of the high infectivity of the new crown virus, it is necessary to further strengthen the sensory control management. Especially with cabin medical care, there is a possibility of ineffective protective equipment under normal pressure, and the risk of infection increases sharply.

Preliminary feedback on clinical trials

The Department of Hyperbaric Oxygen of Wuhan Changjiang Shipping General Hospital performed treatment of two patients with severe NCP in our hospital. Subjective sensation improved significantly the next day after the first hyperbaric oxygen. Later, due to the enhancement of sensory control management, only a daily treatment method was used. After several days of treatment, the patient’s mental state and clinical observations continued to improve, and she is now out of danger. For detailed case information, please consult the attending doctor Zhong Xiaoling, the hyperbaric department of the hospital. Many experts in the hyperbaric oxygen industry have given high praise.

Implementation recommendations for HBOT as NCP supportive care  timing of treatment

Blood oxygen saturation is used as an important evaluation index of disease classification in the guidelines. In theory, diffuse pneumonia hyperbaric oxygen has clear benefits, but in view of the current large-scale patient treatment needs and the limitations of hyperbaric oxygen treatment conditions, it is recommended that atmospheric pressure oxygen therapy can achieve normal blood oxygen saturation (97%) in patients Patients with a continuous decline in blood oxygen saturation (93%, defined as severe in the guidelines) that cannot be maintained by atmospheric oxygen therapy, should take active HBOT as soon as possible. Combined with other comprehensive supportive treatment measures, it is expected to actively delay or prevent disease progression and provide support for the self-limiting recovery of viral infections. Patients who already require invasive mechanical ventilation should use HBOT with caution given the limitations of emergency medical treatment in the chamber.

Treatment programs

Conventional HBOT has no obvious side effects and has been recommended for normal people’s oxygen therapy. Usually once or twice a day, for a course of treatment. In view of the limitations of hyperbaric oxygen therapy technology (large equipment such as an oxygen chamber (multi of mono place) and a limited number of patients at a time), based on the comprehensive clinical evaluation after treatment, the exposure dose (medication dose) of hyperbaric oxygen is flexibly controlled.

consideration of control

Hyperbaric oxygen therapy is widely carried out, and the hygienic management specifications of hyperbaric oxygen equipment have been established to meet the requirements of sensory control. However, given the high infectivity of the new coronavirus, disinfection measures can be further strengthened. The disinfection and medical protection of the treatment process.

Other matters needing attention

The particularity of HBOT, such as misoperation and equipment failure, has a high risk of injury (such as decompression sickness and barotrauma). The equipment and personnel workload caused by the centralized treatment of mass patients with severe NCP is significant. Continuous and strict implementation in accordance with the oxygen chamber operating specifications to ensure the safety of high-pressure exposure is the focus of HBOT.

Implementation of process control

1. The attending doctor evaluates whether HBOT is needed. It is recommended to focus on those who are critically or critically ill: the effect of atmospheric oxygen therapy is not good, the oxygen saturation is still decreasing or the trend continues to decline, but the general state is acceptable, and no interventional treatment and special Caregiver.

2. Transfer: dedicated for special vehicles to avoid cross-infection and to simplify the process of sensory control and disinfection during transfer.

3. Treatment: It has been implemented in the Yangtze River Shipping General Hospital. In addition, it is recommended (1) that the cabin is dedicated to avoid cross-propagation. Disinfection uses the existing oxygen cabin hygiene management process. Increase exhaust and disinfection. Strengthen regional flow control as a polluted area. (2) Manage the hyperbaric oxygen treatment room according to the infection area, including the requirements of medical care and protection. (3) Patients entering the cabin should not need special medical care, and the cabin is not routine. When necessary, medical staff need to be pressurized in a separate cabin and then transferred to a treatment cabin for necessary interventional treatment. Medical care cabins must be pressurized in separate compartments and adequately ventilated before pressurization. (4) The treatment procedure is performed according to conventional HBOT.

Evaluation of treatment capacity

If the special chamber is dedicated and regionally controlled, the disinfection of the original chamber will not increase much, and each set of hyperbaric oxygen equipment will be up to 4 maybe 5 times a day. Each capacity varies depending on the performance of the oxygen chamber, and general seating does not require special medical care, and can accommodate more than 20 people.

Summary

1. The toxic side effects of conventional HBOT are not obvious, but the theoretical expected effect is good, and the actual effect of the case is significant. It’s harmless and likely to be beneficial.

2. HBOT is not a specific medicine, but as a good oxygen therapy method, early intervention can be expected to reduce the incidence of severe and critical illness, thereby reducing medical care pressure, improving treatment efficiency and bed turnover rate. Properly applied, it can play a good role in the treatment of existing large numbers of patients.

3. It is recommended to include hyperbaric oxygen therapy in the Guidelines as a means of choice for the treatment of patients with severe NCP for clinicians to choose.

source:

Chen Ruiyong
Director of HBOT Authority Zhong Xiaoling