The evolving use of hyperbaric oxygen therapy during the COVID-19 pandemic

Abstract

The Sars-CoV-2 (COVID-19) pandemic has resulted in significant and unprecedented shifts in the delivery of health care services in the United States. Although wound care remains an essential service during the COVID-19 pandemic, the financial consequences and infectious disease ramifications of the pandemic have resulted in closure or limitation of hours in many outpatient wound and hyperbaric oxygen therapy (HBOT) centers. As HBOT patients often require daily treatment sessions for a period of months, it is necessary for facilities providing HBOT services to adjust to the COVID-19 pandemic while still maintaining availability of this important service. Modification of HBOT session timing and chamber decontamination procedures, utilisation of telehealth services for initial patient evaluations, and acceptance of novel patient populations and diagnoses are mechanisms by which HBOT centers can adapt to the evolving model of health care delivery throughout a pandemic. While COVID-19 is not a currently accepted indication for HBOT, patients may be referred for HBOT consultation due to the post-infectious sequelae of the virus, and thus HBOT facilities must be aware of the potential uses of this treatment for post-viral complications. By redefining paradigms for health care delivery during the COVID-19 pandemic, HBOT and wound centers can continue to provide high-quality and uninterrupted care to vulnerable patient populations.

Hyperbaric Oxygen Treatment—From Mechanisms to Cognitive Improvement

“…Therefore, it is not surprising that HBOT has been used for over 50 years for wounds (nonhealing diabetic foot ulcers), air embolisms or decompression sickness, burned tissue repair, carbon monoxide intoxication, peripheral arterial occlusive disease, smoke inhalation, radiation injury, and promoting recovery from serious illness [3][4][5][6][7][8][9][10]. Nevertheless, today, there are only 13 FDA-approved HBOTs [11]; however, in parallel, there are a growing number of "off-label" uses, which have not been cleared by the FDA, such as treatment for stroke patients or patients suffering from Alzheimer's disease (AD) [12,13], and even treatment of COVID-19 patients, which have shown very promising results [14][15][16][17][18][19]. Further clinical trials that are currently in progress, and additional basic scientific studies aimed at understanding HBOT's mechanisms of action, will most probably expand the use of HBOT to other areas.…”

The effects of hyperbaric oxygen therapy (HBOT) on coronavirus disease-2019 (COVID-19): a systematic review

“…Approximately, 15–20% of hospitalized patients present with hypoxemic respiratory failure, accompanied by the need for oxygen supplementation [ 14 ]. Hyperbaric oxygen therapy (HBOT) has been proposed as an alternative therapeutic approach to address COVID-19-associated hypoxia [ 12 , 15 ]. HBOT is recognized as an effective treatment for replacing any form of oxygen deficiency [ 14 ].…”

“…In addition, hyperoxygenation of arterial blood with plasma-dissolved oxygen during HBOT has a strong anti-inflammatory effect and may have a direct virucidal impact on COVID-19 [ 20 ]. Preliminary clinical evidence of HBOT treatment in hypoxemic COVID-19 patients demonstrated clinical improvement, e.g., reduce ICU admission and prevent transition to mechanical ventilation [ 15 , 21 ].…”

A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities

“…Notwithstanding the ongoing clinical trials and the efforts of standardize better protocols for safety, COVID-19 is not yet an accepted indication for HBOT, but this may be recommended for post-viral sequelae [ 155 ]. In order to guarantee its beneficial effects, there is still a need of more controlled trials to measure different inflammatory and hematological parameters that demonstrate that exudate and inflammation are reduced besides the improvements in alveolar circulation diffusion.…”