Effects of photobiomodulation therapy combined with static magnetic field (PBMT-sMF) in patients with severe COVID-19 requiring intubation: a pragmatic randomized placebo-controlled trial

Abstract

BackgroundPhotobiomodulation therapy (PBMT) when used isolated or combined with static magnetic field (PBMT-sMF) has been proven benefits on skeletal muscle increasing performance and reducing fatigue, increasing oxygen saturation, and modulating inflammatory process. However, it is unknown whether the effects observed with this therapy on respiratory muscles will be similar to the effects previously observed on skeletal muscles.ObjectiveWe aimed to investigate whether PBMT-sMF is able to decrease the length of stay in the intensive care unit (ICU) and to reduce the mortality rate of patients with severe COVID-19 requiring invasive mechanical ventilation, increasing the respiratory function and modulating the inflammatory process.MethodsWe conducted a prospectively registered, pragmatic, triple-blinded (patients, therapists and outcome assessors), randomized, placebo-controlled trial of PBMT-sMF in patients with severe COVID-19, requiring invasive mechanical ventilation, admitted to the ICU. Patients were randomly assigned to receive either PBMT-sMF (6 sites at the lower thorax – 189 J total, and 2 sites at the neck area – 63 J total) or placebo PBMT-sMF daily during all the ICU stay. The primary outcome was length of stay in the ICU defined by either discharge or death. The secondary outcomes were survival rate, muscle function of diaphragm, change in blood tests, change in mechanical ventilation parameters and change in arterial blood gas analysis.ResultsA total of 30 patients underwent randomization (with 15 assigned to PBMT-sMF and 15 to placebo) and were analyzed. The length of stay in the ICU for the placebo group was 23.06 days while for the PBMT-sMF group was 16.26. However, there was no statistically difference between groups for the length of stay in the ICU (mean difference - MD = - 6.80; 95% CI = - 18.71 to 5.11). Regarding the secondary outcomes were observed statistically differences in favor of PBMT-sMF for diaphragm thickness, fraction of inspired oxygen, partial pressure of oxygen/fraction of inspired oxygen ratio, C-reactive protein, lymphocytes count, and hemoglobin (p<0.05).ConclusionAmong patients with severe COVID-19 requiring invasive mechanical ventilation, PBMT-sMF was not statistically different than placebo to the length of stay in the ICU. However, it is important to highlight that our sample size was underpowered to detect statistical differences to the primary outcome. In contrast, PBMT-sMF increased muscle function of diaphragm, improved ventilatory parameters, decreased C-reactive protein levels and hemoglobin count, and increased lymphocytes count.

Whole‐organ transdermal photobiomodulation (PBM) of COVID‐19: A 50‐patient case study

“…Although small amounts of heat are produced during PBM, the process is photochemical not thermal, invoking biophysical mechanisms offering therapeutic outcomes that thermotherapy cannot. [ 11 ] Reported PBM benefits include reduced tissue inflammation[ 12 ], [ 13 ], [ 14 ] and dyspnea, [ 15 ] improved circulation,[ 16 ] decreased pain[ 17 ] and accelerated recovery. [ 18 ], [ 19 ]…”

“…Although small amounts of heat are produced during PBM, the process is photochemical not thermal, invoking biophysical mechanisms offering therapeutic outcomes that thermotherapy cannot. [11] Reported PBM benefits include reduced tissue inflammation [12], [13], [14] and dyspnea, [15] improved circulation, [16] decreased pain [17] and accelerated recovery. [18], [19] PBM is also found to interfere with a pathogen's ability to replicate [20] through innate immune response (via reactive ion species, [ROS]) and over longer intervals by regulating adaptive immune response.…”

Photobiomodulation therapy (red/NIR LEDs) reduced the length of stay in intensive care unit and improved muscle function: A randomized, triple‐blind, and sham‐controlled trial

“…In a published study that included 45 patients with 18 having established criteria for a ICUAW diagnosis, the hand grip strength (HGD) and the global muscle strength (MRC score) showed good agreement with each other (100% accuracy; Kappa coefficient = 1; p < 0.001) [39]. De Marchi et al [21] also reported interesting results when they applied PBMT combined with a static magnetic field (PBMT-sMF) in ICU patients. Their focus was on severe COVID-19 patients requiring intubation, and their results showed some differences to our study, because they performed the therapy once a day until either ICU discharge or death.…”

“…These effects include increased protein synthesis (muscle hypertrophy), increased synthesis of the muscle energy sources ATP (adenosine triphosphate) and glycogen, and greater resistance to oxidative stress, which produce increased strength and fatigue resistance [11,18]. However, few studies have investigated the effects of PBMT in populations in hospital or intensive care [6,[19][20][21][22]. Moreover, the literature does not contain properly controlled randomized trials of the effects of PBMT in critically ill patients or those admitted to ICUs.…”

Photobiomodulation Therapy as a Possible New Approach in COVID-19: A Systematic Review

“…Another technique that can be useful in this scenario is PBMT when used alone or combined with the static magnetic field (PBMT-sMF). In a study, with patients with severe COVID-19 that required mechanical ventilation were randomly assigned to receive PBMT-sMF (six sites on the lower chest—189 J in total and two sites in the neck area—63 J in total) or PBMT-sMF placebo daily for the entire ICU stay, it was noted that PBMT-sMF was able to improve some ventilatory parameters, in addition to the infectious process, and immune response [ 36 ]. Thus, these techniques suggest that treatment with PBMT-sMF or LLLT may reduce the burden on the hospital and health systems and the use of scarce health care resources during this pandemic [ 33 , 36 ].…”