IntroductionCOVID-19 may cause severe pneumonitis and trigger a massive inflammatory response that requires ventilatory support. The intensive care unit (ICU)-mortality has been reported to be as high as 62%. Dexamethasone is the only of all anti-inflammatory drugs that have been tested to date that has shown a positive effect on mortality. We aim to explore if treatment with hyperbaric oxygen (HBO) is safe and effective for patients with severe COVID-19. Our hypothesis is that HBO can prevent ICU admission, morbidity and mortality by attenuating the inflammatory response. The primary objective is to evaluate if HBO reduces the number of ICU admissions compared with best practice treatment for COVID-19, main secondary objectives are to evaluate if HBO reduces the load on ICU resources, morbidity and mortality and to evaluate if HBO mitigates the inflammatory reaction in COVID-19.Methods and analysisA randomised, controlled, phase II, open label, multicentre trial. 200 subjects with severe COVID-19 and at least two risk factors for mortality will be included. Baseline clinical data and blood samples will be collected before randomisation and repeated daily for 7 days, at days 14 and 30. Subjects will be randomised with a computer-based system to HBO, maximum five times during the first 7 days plus best practice treatment or only best practice treatment. The primary endpoint, ICU admission, is defined by criteria for selection for ICU. We will evaluate if HBO mitigates the inflammatory reaction in COVID-19 using molecular analyses. All parameters are recorded in an electronic case report form. An independent Data Safety Monitoring Board will review the safety parameters.Ethics and disseminationThe trial is approved by The National Institutional Review Board in Sweden (2020-01705) and the Swedish Medical Product Agency (5.1-2020-36673). Positive, negative and any inconclusive results will be published in peer-reviewed scientific journals with open access.Trial registrationNCT04327505. EudraCT number: 2020-001349-37.

Introduction: Diving rebreathers use canisters containing soda lime to remove carbon dioxide (CO 2) from expired gas. Soda lime has a finite ability to absorb CO 2. Temperature sticks monitor the exothermic reaction between CO 2 and soda lime to predict remaining absorptive capacity. The accuracy of these predictions was investigated in two rebreathers that utilise temperature sticks. Methods: Inspiration and rEvo rebreathers filled with new soda lime were immersed in water at 19°C and operated on mechanical circuits whose ventilation and CO 2-addition parameters simulated dives involving either moderate exercise (6 MET) throughout (mod-ex), or 90 minutes of 6 MET exercise followed by 2 MET exercise (low-ex) until breakthrough (inspired PCO 2 [P i CO 2 ] = 1 kPa). Simulated dives were conducted at surface pressure (sea-level) (low-ex: Inspiration, n = 5; rEvo, n = 5; mod-ex: Inspiration, n = 7, rEvo, n = 5) and at 3-6 metres' sea water (msw) depth (mod-ex protocol only: Inspiration, n = 8; rEvo, n = 5). Results: Operated at surface pressure, both rebreathers warned appropriately in four o five low-ex tests but failed to do so in the 12 mod-ex tests. At 3−6 msw depth, warnings preceded breakthrough in 11 of 13 mod-ex tests. The rEvo warned conservatively in all five tests (approximately 60 minutes prior). Inspiration warnings immediately preceded breakthrough in six of eight tests, but were marginally late in one test and 13 minutes late in another. Conclusion: When operated at even shallow depth, temperature sticks provided timely warning of significant CO 2 breakthrough in the scenarios examined. They are much less accurate during simulated exercise at surface pressure.

The permeability properties of composite gas cylinders for breathing gas with polymer inner‐liner are investigated. The cylinder wall can be described as a composite membrane consisting of two layers. The permeability properties of the cylinder are presented as permeability coefficient and permselectivity. Deviation from the expected gas components might lead to incidents and potentially harmful situations when breathing gas from a compressed gas cylinder. Hence, gas permeability and potential changes in gas composition, must be considered when choosing cylinder materials. Cases of decompression sickness initiated this study. Experimental data show that pressure and oxygen fraction in the gas cylinder drops and that the permeability coefficient varies depending on the inner pressure. Permeability coefficients of 0.62–0.90 Barrer for oxygen and 0.44–0.56 Barrer for nitrogen are measured. Cracks in the inner‐liner have caused an accentuated drop in of oxygen fraction and pressure.