Review Is there a rationale for hyperbaric oxygen therapy in the patients with Post COVID syndrome? 2024 Pawlik et al

Abstract

The SARS-CoV-2 pandemic has resulted in 762 million infections worldwide from 2020 to date, of which approximately ten percent are suffering from the effects after infection in 2019 (COVID-19) [1, 40]. In Germany, it is now assumed that at least one million people suffer from post-COVID condition with long-term consequences. These have been previously reported in diseases like Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS). Symptoms show a changing variability and recent surveys in the COVID context indicate that 10–30 % of outpatients, 50 to 70% of hospitalised patients suffer from sequelae. Recent data suggest that only 13% of all ill people were completely free of symptoms after recovery [3, 9]. Current hypotheses consider chronic inflammation, mitochondrial dysfunction, latent viral persistence, autoimmunity, changes of the human microbiome or multilocular sequelae in various organ system after infection.

Hyperbaric oxygen therapy (HBOT) is applied since 1957 for heart surgery, scuba dive accidents, CO intoxication, air embolisms and infections with anaerobic pathogens. Under hyperbaric pressure, oxygen is physically dissolved in the blood in higher concentrations and reaches levels four times higher than under normobaric oxygen application. Moreover, the alternation of hyperoxia and normoxia induces a variety of processes at the cellular level, which improves oxygen supply in areas of locoregional hypoxia. Numerous target gene effects on new vessel formation, anti-inflammatory and anti-oedematous effects have been demonstrated [74]. The provision of intermittently high, local oxygen concentrations increases repair and regeneration processes and normalises the predominance of hyperinflammation. At present time only one prospective, randomized and placebo-controlled study exists with positive effects on global cognitive function, attention and executive function, psychiatric symptoms and pain interference.

In conclusion, up to this date HBO is the only scientifically proven treatment in a prospective randomized controlled trial to be effective for cognitive improvement, regeneration of brain network and improvement of cardiac function. HBOT may have not only theoretical but also potential impact on targets of current pathophysiology of Post COVID condition, which warrants further scientific studies in patients.

Open access, https://link.springer.com/article/10.1007/s00406-024-01911-y

 

Answer: No

 

You see this is quite a significant ‘treatment’ and this artificial distinction that seems to release certain areas from regulations of ‘therapist-delivered’ vs eg drugs really springs to mind here

I won’t go into details why I suspect this but eg compared to trying out b12 injections (where there could be a similar ethos of ‘see if it helps’ and clearing ou free radicals etc) I think this one does run the risk of harm in those trying it for whom it doesn’t work, ie it’s not a case of ‘doesn’t help all’ but there’s something that can be polarised in the body of those pwme who try it that mean some do get what would equate to harm in our books. Whether that’s a huge set-back in their me or maybe there are more dramatic possibilities

so whilst this is interesting I’d think it needs to be being if they are trying it investigated in a very scientific and harm/reaction-first being measured and indeed with an eye out to sub-groups and certainly NOT any get out of jail free usage of drop-outs instead of ‘harm/reaction such that continuing was inappropriate’ and then detailed reporting of the symptoms and details on those people as much as those who might report improvement


Does this fall under any of these clauses of therapist-delivered and therefore ‘light touch’ reporting on harms or is it under the realm of eg drugs or something else?

 

What’s scary is if more severe people truly believe it works, they will risk lots of PEM and permanent worsening just to try the therapy.

 

One rationale is profit for the HBO related businesses.