HBOT treatment of COVID-19
Through the continued dialogue with the Wuhan, China hyperbaric physicians who first applied HBOT to COVID-19 pneumonia and respiratory failure, Dr. Harch received today the latest summary recommendations from them for HBOT in COVID-19 (below). The isolation and disinfection procedures are very important and address the warnings first posted here on 3/17/2020. The recommendations for treatment, however, have changed somewhat from their published experience with the most severely ill patients as they are now recommending a more “practice of medicine” approach as opposed to a rote protocol. While Dr. Harch fully supports this approach and has been encouraging hyperbaric physicians to apply this approach to guide dosing of HBOT for over three decades it is unclear that the Chinese physicians have applied doses greater than 2.0 ATA as they are suggesting in their recommendations.
Of their published 6 cases only one was treated at 2.0 ATA; the other five were treated at 1.6 ATA, including the one ventilator patient. The additional 29 cases were mild cases that appear to have not been treated at elevated pressures of HBOT since they fall outside the algorithm in their recommendations. It doesn’t appear that these recommendations were based on treated cases at other facilities in China or elsewhere. The recommendation for 10 HBOTs is also not supported by their data (the most severely ill non-ventilator patient received 8 HBOTs) and raises the question of the root of this recommendation. Lastly, this escalating dose algorithm for more severely affected patients is above the dosing range of patients who have been treated with HBOT for ARDS. In the absence of documented experience or data for this algorithm it suggests adherence to a habit we have seen throughout the history of hyperbaric medicine, “The Myth of More is Better,” where benefit from HBOT at a dose less than 2.0 ATA suggests a proportionately greater benefit as the pressure of HBOT is escalated. This has proven false in many instances, particularly in the treatment of chronic neurological disorders.
In summary, the attached recommendations from the Wuhan, China hyperbaric medicine team on isolation and sanitation procedures for HBOT in COVID-19 patients appear to be the best information to date on this subject. The recommendations on HBOT dosing are supported for their experience with treatment at 1.6-2.0 ATA and are consistent with the published experience on HBOT in ARDS (the acute respiratory distress syndrome) and Dr. Orval Cunningham’s 1918 Spanish Flu hyperbaric experience.
Please find the demonstration report PDF here: https://drive.google.com/open?id=1S3OguJ_rusbYkEQDMtpSiaCeDwjT_b-O
