Hyperbaric oxygen therapy in preventing mechanical ventilation in COVID-19 patients: a retrospective case series
Hyperbaric oxygen therapy in preventing mechanical ventilation in COVID-19 patients: a retrospective case series
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DOI：
10.12968/jowc.2020.29.sup5a.s4
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发表时间：
2020-05-01
影响因子：
1.9
通讯作者：
Serena, Thomas E.
中科院分区：
文献类型：
--
作者：
Thibodeaux, Kerry;Speyrer, Marcus;Serena, Thomas E.
目标：一场大流行困扰着整个世界。高传染性的SARS-CoV-2病毒于2019年末起源于武汉、中国，并迅速在全球蔓延。根据世界卫生组织(WHO)的数据，新型冠状病毒(新冠肺炎)已在全球感染了200多万人，导致超过16万人死亡。新冠肺炎患者出现一系列症状，从轻微的流感样主诉到危及生命的肺部和心脏并发症。老年人和有潜在疾病的患者患严重急性呼吸系统综合症(SARS)的风险增加，需要机械通风。一旦插管，死亡率就会成倍增加。在大流行期间，研究人员强调了一些药物治疗方案，包括羟氯喹-阿奇霉素、抗病毒疗法(如瑞德韦尔)和抗IL-6药物(如托克珠单抗)，因为这种疗法有可能中断SARS-CoV-2的病毒生命周期或防止细胞因子风暴。目前，还没有一系列决定性的、可重复性的随机临床试验证明任何一种药物或疗法对COVID-19的疗效。原因：单一机构的5名新冠肺炎阳性患者在2020年4月13日至20日期间接受了高压氧治疗。所有患者都有呼吸急促和低氧饱和度，尽管接受了高FiO(2)。添加HBOT是为了防止需要机械通风。标准俯冲剖面为2.0ATA，持续90分钟。患者在两个专用的单一场所高压舱中的一个中接受一到六个治疗。结果：所有患者都康复了，不需要机械通气。高压氧治疗后，血氧饱和度升高，呼吸急促缓解，炎症标志物下降。在撰写本文时，五名患者中的三名已经出院，两名病情稳定。结论：这一小部分患者在接受高压氧治疗后表现出显著的改善。最重要的是，HBOT潜在地阻止了对机械通风的需要。更大规模的研究可能会确定HBOT在治疗这种新疾病中的作用。
Objective: A pandemic afflicts the entire world. The highly contagious SARS-CoV-2 virus originated in Wuhan, China in late 2019 and rapidly spread across the entire globe. According to the World Health Organization (WHO), the novel Coronavirus (COVID-19)has infected more than two million people worldwide, causing over 160,000 deaths. Patients with COVID-19 disease present with a wide array of symptoms, ranging from mild flu-like complaints to life threatening pulmonary and cardiac complications. Older people and patients with underlying disease have an increased risk of developing severe acute respiratory syndrome (SARS) requiring mechanical ventilation. Once intubated, mortality increases exponentially. A number of pharmacologic regimens, including hydroxychloroquine-azithromycin, antiviral therapy (eg, remdesevir), and anti-IL-6 agents (e.g., toclizumab), have been highlighted by investigators over the course of the pandemic, based on the therapy's potential to interrupt the viral life-cycle of SARS-CoV-2 or preventing cytokine storm. At present, there have been no conclusive series of reproducible randomised clinical trials demonstrating the efficacy of any one drug or therapy for COVID-19.Cases: COVID-19 positive patients (n=5) at a single institution received hyperbaric oxygen therapy (HBOT) between 13 and 20 April 2020. All the patients had tachypnoea and low oxygen saturation despite receiving high FiO(2). HBOT was added to prevent the need for mechanical ventilation. A standard dive profile of 2.0ATA for 90 minutes was employed. Patients received between one and six treatments in one of two dedicated monoplace hyperbaric chambers.Results: All the patients recovered without the need for mechanical ventilation. Following HBOT, oxygen saturation increased, tachypnoea resolved and inflammatory markers fell. At the time of writing, three of the five patients have been discharged from the hospital and two remain in stable condition.Conclusion: This small sample of patients exhibited dramatic improvement with HBOT. Most importantly, HBOT potentially prevented the need for mechanical ventilation. Larger studies are likely to define the role of HBOT in the treatment of this novel disease.