Hyperbaric oxygen as an adjuvant treatment for patients with COVID-19 severe hypoxaemia: a randomised controlled trial.

BACKGROUND: Hyperbaric oxygen (HBO2) therapy has been proposed to treat hypoxaemia and reduce inflammation in COVID-19. Our objective was to analyse safety and efficacy of HBO2 in treatment of hypoxaemia in patients with COVID-19 and evaluate time to hypoxaemia correction. METHODS: This was a multicentre, open-label randomised controlled trial conducted in Buenos Aires, Argentina, between July and November 2020. Patients with COVID-19 and severe hypoxaemia (SpO2 ≤90% despite oxygen supplementation) were assigned to receive either HBO2 treatment or the standard treatment for respiratory symptoms for 7 days. HBO2 treatment was planned for ≥5 sessions (1 /day) for 90 min at 1.45 atmosphere absolute (ATA). Outcomes were time to normalise oxygen requirement to SpO2 ≥93%, need for mechanical respiratory assistance, development of acute respiratory distress syndrome and mortality within 30 days. A sample size of 80 patients was estimated, with a planned interim analysis after determining outcomes on 50% of patients. RESULTS: The trial was stopped after the interim analysis. 40 patients were randomised, 20 in each group, age was 55.2±9.2 years. At admission, frequent symptoms were dyspnoea, fever and odynophagia; SpO2 was 85.1%±4.3% for the whole group. Patients in the treatment group received an average of 6.2±1.2 HBO2 sessions. Time to correct hypoxaemia was shorter in treatment group versus control group; median 3 days (IQR 1.0-4.5) versus median 9 days (IQR 5.5-12.5), respectively (p<0.010). OR for recovery from hypoxaemia in the HBO2 group at day 3 compared with the control group was 23.2 (95% CI 1.6 to 329.6; p=0.001) Treatment had no statistically significant effect on acute respiratory distress syndrome, mechanical ventilation or death within 30 days after admission. CONCLUSION: Our findings support the safety and efficacy of HBO2 in the treatment of COVID-19 and severe hypoxaemia. TRIAL REGISTRATION NUMBER: NCT04477954.

Terapia de oxigenación hiperbárica en el tratamiento del dolor / Hyperbaric oxygenation therapy in pain treatment

El dolor crónico constituye un reto terapéutico especial. Se presenta una revisión narrativa sobre el papel del tratamiento de oxigenación hiperbárica (TOHB) en el tratamiento del dolor neuropático, y sus aplicaciones en dolor crónico, síndromes neurosensitivos disfuncionales y oncodolor. El conocimiento de las indicaciones de TOHB en algiología y su aplicación en la práctica médica puede contribuir a mejorar la calidad de vida del paciente. (AU)

Chronic pain represents a special therapeutic challenge. We present a narrative review on the role of Hyperbaric Oxygen Therapy (HBOT) in the treatment of neuropathic pain, and its applications in chronic pain, dysfunctional neurosensitive syndromes and oncological pain. The knowledge of the indications of HBOT in algiology and its application in medical practice can contribute to improve the quality of life of the patient. (AU)

Terapia de oxigenación hiperbárica en individuos sanos: Efecto en algunos parámetros bioquímicos / Hyperbaric oxygen therapy in healthy individuals. Effect on some biochemical parameters

La terapia de oxigenación hiperbárica (TOHB) es usada en el tratamiento de diferentes patologías y es prioritario conocer su injerencia en la bioquímica del paciente y establecer el perfil de seguridad. Con el objetivo de establecer la seguridad y conocer la bioquímica de seguimiento de pacientes que realizan el tratamiento, se realizó un estudio retrospectivo de individuos sanos evaluando el efecto de la TOHB (100% O2 a 1,4 atm) sobre algunos parámetros bioquímicos. Se estudió el estado basal, y a las 10 y 20 sesiones, de los valores de los indicadores de coagulación, hematológicos, función hepática y reactantes de fase aguda. En los 20 individuos sanos no hubo alteraciones en el examen clínico general debido a la exposición a la TOHB. La media (con DE) de los valores bioquímicos a las sesiones 0, 10 y 20 estuvieron siempre dentro del rango de valores de referencia. Estos resultados sugieren que el tratamiento en estas condiciones no produce cambios estadísticamente significativos en los parámetros estudiados.

Hyperbaric oxygenation therapy (HBOT) is used in the treatment of different pathologies and it is a priority to establish its safety profile. A retrospective study in healthy individuals was performed, evaluating the effect of HBOT at 1.4 ATA on biochemical indicators. The general and basal status and after 10 and 20 sessions of biochemical parameters in blood sample, on the biochemical markers of coagulation, hematologic values, hepatic function status, and acute reaction were analysed as well. For the 20 healthy subjects, there were no alterations in the general clinical examination due to exposure to HBOT. The mean values (with SD) of the biochemical parameters at 0, 10 and 20 sessions were mostly within reference values range. The results suggest that the treatment does not produce statistically significant changes in the biochemical parameters studied in these conditions.

A terapia de oxigenação hiperbárica (TOHB) é utilizada no tratamento de diferentes patologias e é prioritário conhecer sua ingerência na bioquímica do paciente e estabelecer o perfil de segurança. A fim de estabelecer segurança e conhecer a bioquímica de monitoramento de pacientes que realizam o tratamento, foi realizado um estudo retrospectivo de indivíduos saudáveis avaliando o efeito da OHB (100% O2 a 1,4 atm) em alguns parâmetros bioquímicos. O estado basal foi estudado e em 10 e 20 sessões os valores de coagulação, hematológicos, função hepática e reagentes de fase aguda foram estudados. Nos 20 indivíduos saudáveis, não houve alterações no exame clínico geral devido à exposição à TOHB. A média (com o DS) dos valores bioquímicos nas sessões 0, 10 e 20 estavam sempre dentro da faixa de valores de referência. Estes resultados sugerem que o tratamento sob estas condições não produz mudanças estatisticamente significativas ao nível dos parâmetros estudados.

Aplicaciones médicas de las cámaras de oxigenación hiperbárica de nueva generación / Medical applications of new generation hyperbaric oxygenation chambers

El uso clínico de la terapia de oxigenación hiperbárica (TOHB) consiste en respirar oxígeno en una concentración cercana al 100% en una cámara presurizada al menos a 1,4 atmósferas absolutas (atm). TOHB actúa produciendo hiperoxia y especies reactivas del oxígeno que desencadenan mecanismos bioquímicos variados. Se presenta una revisión de todas las nuevas aplicaciones emergentes de TOHB en varias especialidades médicas debido a que alcanza beneficios en la cicatrización de heridas, enfermedades inflamatorias y con componente neurológico o isquémico. Las nuevas cámaras realizan el tratamiento a presiones más seguras y con la misma eficiencia demostrada por métodos matemáticos y bioquímicos. El Grupo BioBárica Clinical Research presenta la estadística de las indicaciones en 559 pacientes tratados con estas cámaras en algunos centros médicos y las especialidades médicas implicadas. El uso de TOHB a media presión está en emergencia y podría proveer a futuro evidencia de su efectividad en otras especialidades médicas. (AU)

The clinical use of Hyperbaric Oxygen Therapy (HBOT) consists in breathing oxygen (O2) near to 100% in a pressurized chamber of at least at 1.4 absolute atmospheres (ATA). HBOT acts producing both hyperoxia and reactive oxygen species (ROS) and triggers others biochemical events. The BioBarica Clinical Research Group is developing clinical evidence in diverse pathologies because of accessibility and safety of the new Revitalair hyperbaric oxygen chamber. Because of working at "mild pressure", HBOT performed by these chamber are safer demonstrated by mathematical and biochemical methods. The BioBarica Clinical Research Group presents the statistics of the indications in 559 patients treated with these cameras in some medical centers and the medical specialties involved. Their accessibility to the physicians would become mild pressure HBOT used more frequently proving its effectiveness in other clinical specialties. (AU)