Effects of Hyperbaric Oxygen Therapy in Patient With Acute Upper Limb Finger Gangrene With Covid-19

Abstract

The COVID-19 pandemic (Corona Virus Diseas) was caused by a new beta coronavirus in early 2020, also called Severe Acute Respiratory Syndrome (SARS-CoV-2). Predilection sites of virus entry are the lungs, intestines, blood vessels, kidney, and adipose tissue cells are the virus reservoir. The virus causes a violent reaction of inammatory cytokines - cytokine storm, activation of coagulation and formation of thrombin. The initial coagulopathy of COVID-19 is manifested by a pronounced disorder of D-dimer and brin/brinogen degradation products, while abnormalities in prothrombin time, partial thromboplastin time and platelet count are relatively rare at the onset of the disease. Later, the phenomenon of thrombotic microangiopathy occurs, which is a consequence of inammation of the blood vessels endothelium. In severe cases of infection, thromboembolism or acute thrombosis of peripheral blood vessels may occur. The paper presents a case of a patient with COVID-19 infection in whom, in addition to the usual clinical picture of the disease with changes in lung parenchyma (bilateral pneumonia), thrombosis of the a. radialis and a. ulnaris of the left hand developed, and fteen days after the infection development, the development of gangrene of the distal articles II, III and IV of the nger occurs. In addition to therapy used according to the national guide to COVID-19, hyperbaric oxygen therapy (HBOT) was used. The effect of this therapy was used to increase vascular permeability and create factors that affect angiogenesis and improve blood ow in the ischemic region. HBOT also affected the demarcation of necrotic from healthy tissue, and stimulated wound healing. After two sessions of HBOT treatment, there was a complete restitution of blood ow with full function of the left hand and all its ngers.