|Year : 2020 | Volume
| Issue : 3 | Page : 133-134
COVID-19 and HBOT: A conceptual standpoint
Medical Officer Specialist (Aerospace Medicine), AF Station Jamnagar, Gujarat, India
|Date of Submission||10-Aug-2020|
|Date of Decision||16-Aug-2020|
|Date of Acceptance||24-Sep-2020|
|Date of Web Publication||09-Oct-2020|
Flt Lt (Dr) Gaurab Ghosh
AF Station, 33 Wing, Jamnagar - 361 003, Gujarat
Source of Support: None, Conflict of Interest: None
The Role of Hyperbaric Oxygen Therapy as an adjunct to treating patients with severe –COVID-19 infection is critical in recovery outcome of the patients as discussed in the articles reviewed in this paper and it will form a basis to develop treatment protocol for HBOT for COVID-19 patients by hyperbaric medical authorities. The critical standpoints in respect of pathophysiology and pharmacodynamics are emphasized in this paper.
Keywords: COVID-19, HBOT, ARDS
|How to cite this article:|
Ghosh G. COVID-19 and HBOT: A conceptual standpoint. J Mar Med Soc 2020;22, Suppl S1:133-4
| Introduction|| |
On January 31, 2020, the WHO, following the recommendations of its Emergency Committee, declared the novel coronavirus disease 2019 (COVID-19) outbreak as a public health emergency of international concern. There was an amplified number of ICU admissions and deaths due to COVID-19-related respiratory illnesses, and India was no exception to this pandemic blowout. Several pharmacological agents showed promise, such as remdesivir, azithromycin and hydroxychloroquine. Use of dexamethasone, convalescent plasma, and immunomodulatory drugs also underwent clinical trials, but the data supporting their use are limited to small retrospective cohort studies, case series, and case reports. Role of HBO has also been deliberated upon for the management of severe COVID-19 infections and this paper aims to discuss its conceptual justification.
| Role of Hbo in Covid-19-Related Ards|| |
Inflammatory exudative pneumonia in severe COVID-19 infection results in hypoxemia due to mismatch, pathological shunts and perfusion defects by microthrombi and mucous plugging, and diffusion impairment by thickened alveolar membranes. Most patients' best sPO2 even with 100% FiO2 and high positive end expiratory pressure is around 60%. With progression of disease, standard normobaric treatment fails to penetrate the barriers at the capillary–alveolar interface, resulting in oxygen debt and deterioration of saturation. This is probably why most young COVID-19 patients with no comorbidities are also turning hypoxic. HBO exploits Henry's Law which states that the amount of dissolved gas (alveolar oxygen) in a liquid is proportional to its partial pressure above the liquid (pulmonary blood). It enhances oxygen diffusion through the inflamed membrane and increases dissolved oxygen concentration in plasma and delivery to microcirculation. The outcome of three studies supports the evidence as they suggested that early morning HBOT (when hypoxia is at maximum) was useful in correcting systemic hypoxemia and effort mechanical ventilation.,, Its persistent aftereffects are also considered beneficial as serial high-pressure hyperoxia enhances upregulation of anti-inflammatory genes, growth factors, and cell signaling molecules. The physiology is not unprecedented as these are considered basic rationale behind utilization of HBO in several UHMS justified treatment indications.
| Safety Precautions|| |
Ideally, the chambers should be located in a negative pressure room with viral filters and air purification systems in place. The patient must be monitored and preoxygenated during transport. The unit should have a cardiac monitoring set up. It is very important to ensure patient safety as they are morbid, unstable (especially during air breaks), and can potentially decompensate. An exposure time of 90 min/day at 2.0 ATA for an average of 5 days was considered an adequate treatment period for durable recovery., Postrun hypoxia is also a common finding; hence, the patients should be transferred out while on supplemental oxygen. It is imperative that the entire procedure is carried out in full PPE and the room is disinfected with approved agents after each use.
| Conclusion|| |
The papers discussed the option of using HBO as an adjunct to treating patients of severe COVID-19 infection. To recommend, a target protocol for administering HBO needs to be devised by signatory authorities for a more promising outcome.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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