Physiologic and biochemical rationale for treating COVID-19 patients with hyperbaric oxygen.

The SARS-Cov-2 (COVID-19) pandemic remains a major worldwide public health issue. Initially, improved supportive and anti-inflammatory intervention, often employing known drugs or technologies, provided measurable improvement in management. We have recently seen advances in specific therapeutic interventions and in vaccines. Nevertheless, it will be months before most of the world's population can be vaccinated to achieve herd immunity. In the interim, hyperbaric oxygen (HBO2) treatment offers several potentially beneficial therapeutic effects. Three small published series, one with a propensity-score-matched control group, have demonstrated safety and initial efficacy. Additional anecdotal reports are consistent with these publications. HBO2 delivers oxygen in extreme conditions of hypoxemia and tissue hypoxia, even in the presence of lung pathology. It provides anti-inflammatory and anti-proinflammatory effects likely to ameliorate the overexuberant immune response common to COVID-19. Unlike steroids, it exerts these effects without immune suppression. One study suggests HBO2 may reduce the hypercoagulability seen in COVID patients. Also, hyperbaric oxygen offers a likely successful intervention to address the oxygen debt expected to arise from a prolonged period of hypoxemia and tissue hypoxia. To date, 11 studies designed to investigate the impact of HBO2 on patients infected with SARS-Cov-2 have been posted on clinicaltrials.gov. This paper describes the promising physiologic and biochemical effects of hyperbaric oxygen in COVID-19 and potentially in other disorders with similar pathologic mechanisms.

Rapidly Developing Large Bilateral Cataracts in a 58-Year-Old Woman After Only 46 Hyperbaric Oxygen Treatments.

We are reporting a 52-year-old female that developed documented vision impairing, large, bilateral nuclear and cortical cataracts during therapy after 46 treatments of a planned 60 treatment course of HBO2 for a non-healing post-radiation leg wound. A review of the available literature makes this one of the earliest cases of cataract formation.

Hyperbaric Oxygen Therapy Emergencies.

Emergent indications for HBO2 are not only for some of the most serious conditions, but also may be the only modality to directly target the patient's pathophysiology. They are to begin emergently or urgently, but may be limited by either the instability of the patient's condition or transfer logistics. Often these emergent treatments involve several treatments in the first 24 hours for best outcomes. If one considers the effects of HBO2 upon the body while breathing 100% oxygen at pressure many benefits become evident. This article will concisely review hyperbaric oxygen's emergent indications.

Hyperbaric Oxygen Therapy as an Elective Treatment.

Hyperbaric oxygen therapies may have grown out of emergencies such as those for Decompression Sickness (DCS), but more commonly in the U.S., hyperbaric oxygen is used for much more elective problems. Wound healing applications lead this trend. Nationally many more hyperbaric centers exist to treat elective problems adjunctively, and this is a concise review of these indications as well as pointing out where even elective centers might be able to broaden their practices.

Hyperbaric Oxygen Indications: Diabetic Foot Ulcers and Intractable Management.

Wound care remains an interdisciplinary specialty that can confront primary care physicians, emergency medicine physicians, and even specialists with increasingly challenging clinical dilemmas as well as an increasing array of possible additional therapies, like HBO2. As everyone tries to offer what's best, it remains to each individual clinician to weigh the patient's presenting problem, like a lower extremity or diabetes mellitus foot ulcer and potential therapies, such as HBO2.

The Diagnosis of Decompression Sickness in Sport Divers.

Hyperbaric oxygen therapy (HBO2) remains the primary treatment for decompression sickness (DCS)-which can be obviously serious or infrequently more minor and can get missed outside of centers that routinely handling diving medicine. This review will point out the salient items for how sport or amateur divers might present for HBO2.

Hyperbaric Oxygen Therapy and Radiation-Induced Injuries.

Initial clinical uses of hyperbaric oxygen (HBO2) capitalized upon physical effects to drive offending gases back into solution and deliver more oxygen to tissues in early treatments of decompression sickness. HBO2 has a myriad of other effects, including stimulating angiogenesis and new cellular in growth for healing.