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 Table of Contents  
CORRESPONDENCE
Year : 2020  |  Volume : 22  |  Issue : 3  |  Page : 133-134

COVID-19 and HBOT: A conceptual standpoint


Medical Officer Specialist (Aerospace Medicine), AF Station Jamnagar, Gujarat, India

Date of Submission10-Aug-2020
Date of Decision16-Aug-2020
Date of Acceptance24-Sep-2020
Date of Web Publication09-Oct-2020

Correspondence Address:
Flt Lt (Dr) Gaurab Ghosh
AF Station, 33 Wing, Jamnagar - 361 003, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_112_20

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  Abstract 


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

How to cite this URL:
Ghosh G. COVID-19 and HBOT: A conceptual standpoint. J Mar Med Soc [serial online] 2020 [cited 2020 Nov 28];22, Suppl S1:133-4. Available from: https://www.marinemedicalsociety.in/text.asp?2020/22/3/133/297662




  Introduction Top


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.[1] 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.[2] 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 Top


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.[3] 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.[4] 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.[5],[6],[7] Its persistent aftereffects are also considered beneficial as serial high-pressure hyperoxia enhances upregulation of anti-inflammatory genes, growth factors, and cell signaling molecules.[8] The physiology is not unprecedented as these are considered basic rationale behind utilization of HBO in several UHMS justified treatment indications.[8]


  Safety Precautions Top


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.[6],[7] 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 Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Situation Report 11. Geneva:Published by: WHO R& D team;2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situationreports/20200131-sitrep-11-ncov.pdf?sfvrsn=de7c0f7_4. [Last accessed on 2020 Jul 30].  Back to cited text no. 1
    
2.
Rajendran K, Krishnasamy N, Rangarajan J, Rathinam J, Natarajan M, Ramachandran A. Convalescent plasma transfusion for the treatment of COVID-19: Systematic review. J Med Virol 2020:10.1002/jmv.25961. doi: 10.1002/jmv.25961. Epub ahead of print. PMID: 32356910; PMCID: PMC7267113.  Back to cited text no. 2
    
3.
Santamarina MG, Boisier D, Contreras R, Baque M, Volpacchio M, Beddings I. COVID-19: A hypothesis regarding the ventilation-perfusion mismatch. Crit Care 2020;24:395.  Back to cited text no. 3
    
4.
Dhont S, Derom E, Van Braeckel E, Pieter D, Bart NL. The pathophysiology of 'happy' hypoxemia in COVID-19. Respir Res 2020;21:198.  Back to cited text no. 4
    
5.
Zhong X, Tao X, Tang Y, Chen R. The outcomes of hyperbaric oxygen therapy to retrieve hypoxemia of severe novel coronavirus pneumonia: first case report. Zhonghua Hanghai Yixue yu Gaoqiya Yixue Zazhi. 2020. doi: 10.3760/cma.j.issn.1009-6906.2020.0001.  Back to cited text no. 5
    
6.
Zhong XL, Niu XQ, Tao XL, Chen RY, Liang Y, Tang YC. The First Case of HBOT in Critically Ill Endotracheal Intubation Patient with COVID-19. Beijing, China: Novel Coronavirus Pneumonia Research Network Sharing Platform of China Association for Science and Technology; 2020.  Back to cited text no. 6
    
7.
Ruiyong Chen, Xiaoling Zhong, Yanchao Tang, Yi Liang, Bujun Li, Xiaolan Tao, Changbo Liao. The Outcomes of Hyperbaric Oxygen Therapy to severe and critically ill patients with COVID-19 pneumonia. Available on:https://oxycamaras.com.br/wp-content/uploads/2020/04/Outcome-of-HBOT-to-COVID19.pdf.pdf.pdf.pdf.pdf. [Last accessed on 2020 Sep 20].  Back to cited text no. 7
    
8.
Weaver MK. Hyperbaric Oxygen Therapy Indications. 13th ed. Durham, USA: The Hyperbaric Oxygen Therapy Committee Report; 2014. Available from: https://www.uhms.org/images/indications/UHMS_HBO2_Indications_13th_ed._Front_Matter__References.pdf. [Last accessed on 2020 Jul 30].  Back to cited text no. 8
    




 

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Abstract
Introduction
Role of Hbo in C...
Safety Precautions
Conclusion
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