Hyperbaric medicine is used to treat various health problems and diseases, such as severe anemia, brain injuries, burns, carbon monoxide poisoning, among many others. Since the onset of the Covid-19 pandemic, some institutions have begun to apply it as a complement to standard coronavirus treatment in some patients.
Also known as hyperbaric oxygen therapy (OHB), this therapy is based on the medical application of 100% pure oxygen in a pressurized chamber, at pressures two to three times greater than the ambient pressure at sea level.
The oxygen applied to these pressures is done more soluble in blood and enters the all tissues, eliminating hypoxia (lack of oxygen) more effectively than any other method.
The first to use hyperbaric oxygen (OHB) in patients with Covid-19 were Chinese doctors, who showed a rapid improvement in the recovery of oxygen supply throughout the body, affected by the disease.
In fact, the UHMS (Undersea and Hyperbaric Medical Society), the leading international society in this branch of medicine, set its sights on the research they carried out and recommended and encouraged more work to be done. evidence-based style around the world.
Preliminary results in one small number of patients were obtained in some hyperbaric medicine centers in the USA and Sweden.
Mariana Cannellotto, President of the Argentine Association of Hyperbaric Medicine and Research (AAMHEI) Clarín that there are currently several published scientific papers on cases treated in Europe, the United States and Canada and the results recorded so far suggest that OHB may contribute favorably to the recovery of patients with hypoxemic pneumonia by Covid-19 avoiding, in some cases, that the patient needs to reach the respirator and reducing the risk of multiorgan failure caused by hypoxemia and complications, if applied in time.
In Argentina it is being applied in three hospitals: Santojanni, Muñiz and the Central San Isidro.
“Like everything we have so far in relation to Covid-19, more studies are still needed to be able to state this. The significant difference of OHB in relation to other treatments is that is indicated as an adjuvantThat is, along with the indicated standard treatment. It is a supplement that allows to increase the arrival of oxygen to tissues, reduce cellular oxidative stress, reduce inflammatory interleukins, improve immunity and repair tissue damage caused by lack of oxygen, “says Cannellotto .
Sessions are conducted inside pressurized chambers. Photo Shutterstock.
Regarding the experience gained in the context of the pandemic, doctor Nina Subbotina, professor of medicine and author of books on hyperbaric medicine, told Clarín that “it was possible to demonstrate the effectiveness of OHB in the treatment of patients with Covid- 19 decreasing the need for intubation and mechanical respiratory care in severe patients and clearly reducing mortality among severe, severe, and moderate cases using a patient scoring system that provides excellent stratification of outcomes and allows for statistically significant comparison with international data. ”
Subbotina, who was born in the former Soviet Union and has lived in Argentina since 1992, where he came to attend a conference on Hyperbaric Medicine, says that hyperbaric oxygen helps to treat extreme hypoxia, so characteristic of the new SARS-CoV-2 coronavirus.
“Oxygen saturation is recovered to acceptable values from the first sessions of OHB and 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 recovers the state of the immune system. Its anti-inflammatory effect is very important “, emphasizes Subbotina, who directs the superior course of hyperbaric medicine favored by the Argentine Medical Association (AMA).
Sessions in covid patients last 90 minutes. Photo Shutterstock.
Characteristics of the treatment
As for 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 reservoir is placed, the chamber is closed and the 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 subsequent saturation is controlled. The number of sessions varies from 5 to 10 on a daily basis.
“The goal of the OHB is to achieve one greater dissolution of oxygen in the plasma. Regardless of its transport by hemoglobin and the better arrival of the same to the tissues, through the diffusion and penetration of O2 from the plasma to all cells, OHB generates a strong hyperoxia (excess oxygen) “, emphasizes the doctor.
“In patients with Covid-19 hypoxemic pneumonia continues – oxygen does not diffuse properly from the lung to the red blood cell due to the inflammation that occurs in it, this affects oxygen transport, The supply of the same, cellular respiration and energy production by the cell, leading to a cascade of pathophysiological events with worsening of cellular functions and multiorgan failure. “
“By increasing the diffusion of pulmonary capillary alveoli, OHB allows greater dissolution of oxygen, reduces cellular oxidative stress and inflammation, improves cellular immunity. Fewer days of hypoxia, less damage , higher recovery, fewer sequelae. And, of course, lower risk of mortality, “Cannellotto said.
One of the criteria, says Subbotina, to start treatment in the hyperbaric chamber is the drop in oxygen saturation below 93% so, it suggests, it is preferable not to waste time in starting treatment with OHB.
“I recommend it for patients with low oxygen saturation that determines a likely worsening in its state, which can be fulminating. The main meaning of OHB treatment is to avoid the need to apply mechanical respiratory assistance, so it is necessary to start treatment early, when the drop in oxygen saturation has recently been observed, ”he concludes.