Application of hyperbaric oxygenation in patients with a new coronavirus infection COVID-19: prospective study

OBJECTIVE: To study the effect of hyperbaric oxygenation HBO on the dependence of COVID-19 patients on constant oxygen support and clinical and biochemical parameters that are markers of the severity of this pathological condition.
MATERIAL AND METHODS: 30 patients were examined with the diagnosis of “Coronavirus infection caused by the SARS-CoV-2 virus” (20 - CT1-2 patients, 10 – CT 3-4 patients) who were on constant oxygen support from the first day of admission to the hospital. Twenty patients (the main group) were assigned a six-day course of hyperbaric oxygenation (HBO) in the mode of 1.4 ata - 60 min, one session per day. The procedure was carried out in the domestic pressure chamber “BLKSM”. At the time of the appointment of the HBO course, the patients were on endonasal oxygen supply for 3 to 5 days (EOS, 8-10 liters per minute) or from 2 to 4 days on noninvasive ventilation of the lungs (NIVL). The indication for the appointment of HBO was the inefficiency of the oxygen support provided. Before and after each HBO session, the patient’s subjective state was assessed, blood oxygen saturation was measured, the dynamics of the content of leukocytes, platelets, C-reactive protein (CRP), ferritin and transferase activity were evaluated. The control group (10 people) consisted of COVID-19 patients who had contraindications to the use of HBO (claustrophobia, bullous lung disease). Statistics. Statistical processing of the obtained data was carried out using the program “Statistica 10.0” (Dell Inc., USA).
RESULTS: Already by the 3rd HBO session, five out of 10 COVID-19 c CT1-2 patients did not need constant oxygen support, and 4 out of 5 COVID-19 c CT 3-4 patients switched from NIV to EOS. After the 6th HBO session, only one patient needed constant oxygen support (EOS), which was canceled 4 days after the end of the HBO course. There was no lethality in this group. In patients of the control group, oxygen support was distributed as follows: on the first day - 8 people on EOS, 2 on NIVL; on day 3- 4 people on EOS, 6 on NIVL; on day 7 -3 people on EOS, 4 on NIVL, two on invasive ventilation of the lungs (IVL). By the 14th day, five people did not need constant oxygen support, 2 on EOS. 1 on NIVL; two patients who were on a ventilator died. In the main group, the elimination of hypoxemia was noted on the 6th day of HBO use, whereas in the control group it persisted by the 14th day of treatment. Regardless of the severity of the pathological process, the use of HBO caused a decrease in the content of blood leukocytes, not exceeding the lower limit of the norm, reduced the degree of hyperferritinemia. The rate of decrease in the blood of C-reactive protein (CRP) under the influence of HBO was inversely dependent on the severity of the pathological condition.
DISCUSSION: The rapid refusal of patients with COVID-19 from constant oxygen support during the course of the use of HBO indicates the ability of hyperbaric oxygen to eliminate violations of the gas exchange function of the lungs. At the same time, HBO has an anti-inflammatory effect on the sick body, acting as a synergist with drug therapy, which is manifested by a decrease in the content of acute phase proteins in the blood and the elimination of leukocytosis. The rate of decrease in the blood of C-reactive protein (CRP) under the influence of HBO was inversely dependent on the severity of the pathological condition.
CONCLUSION: Course application of HBO in 1.4 ata mode, 50 min, one session per knock. It is an effective method of treating respiratory failure and preventing its progression in patients with COVID-19.