Hyperbaric medicine is used to treat various health problems and diseases, such as severe anemia, brain damage, burns, carbon monoxide poisoning, among many others. Since the beginning of the Covid-19 pandemic, some institutions have begun to apply it as a supplement to standard coronavirus treatment in some patients.
Also known as hyperbaric oxygen therapy (HBO), this therapy is based on the medical application of 100% pure oxygen in a pressurized chamber, at pressures two to three times higher than the ambient pressure at sea level.
The oxygen applied to these pressures becomes more soluble in the blood and penetrates all tissues, eliminating hypoxia (lack of oxygen) more effectively than any other method.
The first to use hyperbaric oxygen (HBO) in patients with Covid-19 were Chinese doctors, who showed a rapid improvement in the recovery of oxygen supply to the whole body, affected by the disease.
In fact, UHMS (Undersea and Hyperbaric Medical Society), the international governing body in this field of medicine, has set its sights on the research they have conducted and recommended and encouraged the development of more evidence-based work of this kind. from all over the world .
Preliminary results a small number of patients were obtained from some hyperbaric medicine centers in the USA and Sweden.
Mariana Cannellotto, president of the Argentine Association of Hyperbaric Medicine and Research (AAMHEI), says Clarion that there are currently several published scientific studies of cases treated in Europe, the United States and Canada, and the results so far suggest that HBO may contribute favorably to the recovery of patients with hypoxemic pneumonia by Covid-19 avoiding, in some cases, that the patient must reach the respiratory tract and reduce the risk of multi-organic insufficiency caused by hypoxemia and complications, if it can be applied in time.
In Argentina it is applied in three hospitals: Santojanni, Muñiz and in Central de San Isidro.
“Like everything we have so far about Covid-19, more studies are still needed to be able to say this. The significant difference of HBO compared to other treatments is that indicated as an adjuvant, ie together with the indicated standard treatment. It is a supplement that increases the arrival of oxygen in the tissues, reduces cellular oxidative stress, reduces inflammatory interleukins, improves immunity and repairs tissue damage caused by lack of oxygen, “says Cannellotto.
The sessions take place inside the pressure chambers. Photos Shutterstock.
Regarding the experience gained during the pandemic, Dr. Nina Subbotina, professor of medicine and author of hyperbaric medicine books, told Clarín that “it was possible to demonstrate the effectiveness of HBO in the treatment of patients with Covid- 19 decreasing the need for intubation and mechanical ventilation in critically ill patients and a clear reduction in mortality in severe, severe and moderate cases using a patient scoring system that provides excellent stratification of outcomes and allows comparison with statistically significant international data. “
Subbotina, who was born in the former Soviet Union and has lived in Argentina since 1992, where she attended a hyperbaric medicine congress, says hyperbaric oxygen helps treat extreme hypoxia, so characteristic of the new SARS-CoV-2 coronavirus.
“Oxygen saturation is recovering up to acceptable values from the first HBO sessions to normal values as treatment progresses. Hyperbaric oxygen prevents the storm of cytokines typical for this disease, responsible for the critical evolution of patients. It compensates for the rapidly accumulating oxygen debt and restores the state of the immune system. Its anti-inflammatory effect is very important “, emphasizes Subbotina, who leads the higher course of hyperbaric medicine sponsored by the Argentine Medical Association (AMA).
Sessions in covid patients last 90 minutes. Photos Shutterstock.
Treatment characteristics
Regarding the form of administration, Cannellotto explains that the patient enters the hyperbaric chamber, where the previous saturation is measured and an oxygen mask with a tank is placed, the chamber is closed and pressurization process where the pressure inside the chamber increases progressively to the treatment pressure in the protocol (in Argentina it is up to 1.45 ATM).
The treatment time in patients with Covid-19 is 90 minutes. At the end of the session, the depressurization process begins, the patient is removed from the room and the subsequent saturation is controlled. The number of sessions varies daily from 5 to 10.
“OHB ‘s goal is to achieve a greater dissolution of oxygen in plasma. Regardless of its transport by hemoglobin and its better arrival in the tissues, by the diffusion and penetration of O2 from the plasma to all cells, HBO generates a strong hyperoxia (excess oxygen) “, the doctor emphasizes.
“In patients with hypoxemic pneumonia due to Covid-19, oxygen does not diffuse properly from the lungs to the red blood cells due to the inflammation that occurs in it, this affects oxygen transport, its supply, cellular respiration and energy production by the cell, leading to a cascade of pathophysiological events with worsening cellular functions and multi-organ failure. “
“By increasing the pulmonary diffusion of the capillary alveoli, HBO allows greater oxygen dissolution, reduces cellular oxidative stress and inflammation, improves cellular immunity. Fewer days of hypoxia, less damage, greater recovery, fewer sequelae. And, of course , a lower risk of mortality “. says Cannellotto.
One of the criteria, Subbotina points out, for starting treatment in a hyperbaric chamber is decrease in oxygen saturation below 93%, so, he suggests, it’s best not to waste time starting HBO treatment.
“I recommend it to patients who have a low oxygen saturation that causes a probable aggravation in its state, which can be devastating. The main purpose of HBO treatment is to avoid the need to apply mechanical ventilation, for this it is necessary to start treatment early, when the decrease in oxygen saturation is only observed “, he concludes.