WCJC #9 - COVID-19 and HBOT
Hyperbaric oxygen therapy in preventing mechanical ventilation in COVID-19 patients: a retrospective case series
Kerry Thibodeaux, MD; Marcus Speyrer, MD; Amer Raza, MD; Raphael Yaakov,
MD; Thomas E Serena, MD
Journal of Wound Care North American Supplement Vol 29, No 5, May 2020
Life right now is turned upside down because of COVID-19. Being a novel infection, there are no disease-specific treatments, as of yet. Most patients have mild symptomatic disease, and many may never be symptomatic. Still, for those who do become severely ill, mechanical ventilation has been associated with a sharp increase in mortality. In my institution, I was asked about the possible use of hyperbaric oxygen therapy (HBOT) for COVID-19. When I looked in March, there was no literature regarding that. Things have changed, and now there is a publication regarding HBOT and COVID-19.
This article reports on a retrospective case series of five patients with COVID-19. They were imminent to be placed on mechanical ventilation but were instead treated with HBOT at 2.0 ATA for 90 minutes, followed by five additional daily treatments.
All five patients avoided intubation.
The mean respiratory rate was 35.4 before HBOT and dropped to 28 after the first treatment. This was a rapid improvement in tachypnea.
D-Dimer on admission has been reported to correspond with a poor outcome. A D-Dimer was reported on the first patient at 12,070 mg/ml before HBOT and decreased to 4,324 mg/ml within 24 hours.
Less than a week after the last HBOT, three of the five patients were discharged, and the remaining two were in stable condition.
There were no complications from HBOT.
The authors conclude that this study supports further research into the use of HBOT for symptomatic COVID-19.
Given the reports that patients with COVID-19 who are placed on ventilators are difficult to wean with a sharp increase in mortality, it makes sense to explore treatment options to decrease the need for intubation. While this study is very small, given the lack of any approved treatments for COVID-19, it makes sense to start a large prospective clinical trial for the use of HBOT with COVID-19. In the meantime, more centers using the treatment under compassionate use rules and then reporting their results would be helpful.
Since most HBOT is occurring in outpatient wound care centers, there will only be a limited number of hospitals that can currently offer this treatment to these severely ill patients. However, if more data comes in to support the use of HBOT with COVID-19, then it would make sense for health systems with hyperbaric oxygen chambers located in the hospital to explore how to treat these patients safely.