月度归档： 2020 年 2 月

Oxygen Therapy is Effective to Help the Immune Response Fight COVID-19

There is currently no vaccine to prevent coronavirus disease COVID-19, yet research is on the way to find antivirus and the results are currently promising.

We have compiled an article to showcase a few vital information that is currently relevant to the virus outbreak to help you understand the basics.

First, it’s important to understand how the virus is spread, so we can stay safe from it. The virus mainly spreads through an infected person’s nose or mouth into your eyes, nose or mouth. The best way to prevent the illness is to avoid being exposed to this virus, avoid sneeze or cough droplets from people that may be infected, avoid human interaction in very populated areas as much as you can. It is important that you don't panic.

According to this article documented and published by OxyMed, the virus COVID-19 initially affects the lungs.

• As with other coronavirus illnesses — including SARS, MERS, and the common cold — COVID-19 is a respiratory disease, so the lungs are usually affected first.
• Early symptoms include fever, cough, and shortness of breath. These appear as soon as 2 days, or as long as 14 days, after exposure to the virus.
• The severity of COVID-19 varies from mild or no symptoms to severe or sometimes fatal illness.
• Some people may only have minor respiratory symptoms, while others develop non-life-threatening pneumonia. But there’s a subset of people who develop severe lung damage.
• There are no targeted therapeutics or vaccines for the new virus — and so doctors and nurses in the ICUs are left to administer drugs and oxygen to keep patients alive long enough for their bodies to fight the infection and repair lungs ravaged by pneumonia.
• As the virus attacks the lungs, it becomes harder and harder for patients to get enough oxygen into their bloodstream to support their kidneys, liver, and heart, and they develop acute respiratory distress syndrome (ARSD).
• These ARSD induces damage to the lungs, which leads to fluid leaking from small blood vessels in the lungs. The fluid collects in the lungs’ air sacs or alveoli. This makes it difficult for the lungs to transfer oxygen from the air to the blood – induced hypoxia.
• One recent study of 138 people hospitalized for COVID-19 found that on average, people started having difficulty breathing 5 days after showing symptoms. ARDS developed on average 8 days after symptoms.
• Treatment for ARDS involves supplemental (normobaric and hyperbaric) oxygen and mechanical ventilation, with the goal of getting more oxygen into the blood.

Oxygen Therapy

Oxygen Therapy including Normobaric and Hyperbaric Oxygen target the internal cellular metabolism (cytokine storm syndrome). Oxygen Therapies are effective in treating both the primary infection but also the cascading secondary challenges associated with the coronavirus immune response.

According to Dr. Paul Harch

“In the midst of the coronavirus epidemic/pandemic, it bears remembering the application of hyperbaric oxygen therapy to the last major pandemic that impacted the United States in 1918, the Spanish Flu Pandemic. Death was primarily by pulmonary infection and its attendant hypoxemia and respiratory failure.

The first application of hyperbaric medicine to a Spanish Flu victim was likely also the first application to a human being in the United States. In 1918 Dr. Orval Cunningham of Kansas City was brought a dying friend of a fellow physician. The patient was moribund and blue. Before Cunningham could perform his planned animal experiments he was asked to treat this dying patient. With just a one-hour treatment with compressed air at 1.68 atmospheres absolute, the patient experienced improvement. Combined with additional hyperbaric treatments over the next 3 days this patient’s life was saved.  Others followed.

Today’s coronavirus’ mortality is due to pulmonary infection and respiratory failure. While there are differences between the Spanish Flu and coronavirus the primary pathology is in the lungs, the first organ of contact with hyperbaric therapy beyond the skin. The ability of hyperbaric oxygen to penetrate inflammatory pulmonary secretions allows adequate oxygen to reach the blood while inhibiting the inflammatory process. Applied correctly, hyperbaric therapy may have utility in coronavirus patients similar to its life-saving history with the Spanish Flu.

You can read the article on Harch Hyperbarics Inc website https://hbot.com/hyperbaric-application-to-covid-19-pulmonary-infection/

What to do during the COVID-19 outbreak and how to stay safe?

Avoid information from unofficial sources. Choose to inform yourself from Government sources, your Ministry of Health or the World Health Organisation. Similar to other respiratory diseases, COVID-19 infection can cause mild symptoms, including nasal leaks, sore throat, cough, and fever. It may manifest more severe for some people and may cause pneumonia or shortness of breath.

Take care of your health and protect others:

• Wash your hands often with soap and water for at least 30 seconds especially after making contact with public places.
• Avoid contact with people who are suspected of acute respiratory infections.
• Avoid touching your eyes, nose, and mouth with your hands.
• Cover your mouth and nose when you sneeze or cough.
• Do not take antiviral drugs or antibiotics unless prescribed by your doctor.
• Clean all surfaces with chlorine or alcohol-based disinfectants.
• Use the protective mask only if you suspect that you are sick or if you are assisting the sick.

Why Justin Bieber Sleeps in a Hyperbaric Oxygen Chamber?

Pop singer, Justin Bieber says that he uses a hyperbaric oxygen chamber and gets IV infusions in order to rid his body of toxins "built-up" after several years of drug abuse: "I've abused my body in the past and now I'm just in the recovery process trying to make sure I'm taking care of my body and taking care of the vessel that God's given me."

Bieber has at least two hyperbaric chambers, one at home and the other at his studio. He explains: "It fills up with oxygen, I really have been struggling with a lot of anxiety. You get more oxygen to your brain so it decreases your stress levels. It's pretty cool."

Bieber also takes antidepressants for depression and anxiety. The medications help him "get outta bed in the morning." The IV infusions he receives are NAD+ (nicotinamide adenine dinucleotide) infusions to increase his energy level (perhaps the subject of another column in the near future).

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy (HBOT) involves breathing oxygen in a pressurized chamber in which the atmospheric pressure is raised up to three times higher than normal. HBOT can be used as a primary treatment or as an adjuvant to surgical and/or pharmacologic interventions.

Note that HBOT is not topical oxygen therapy, sometimes called normobaric oxygen therapy (NBOT). NBOT is the type of oxygen commonly used in hospitals and clinics for patients with lung or heart disease, perioperatively, or for a variety of other medical conditions. A gas mixture with a prescribed percentage of oxygen is given by nasal prongs, face mask, or intubation tube. Adjustments to the oxygen content are based on the clinical response. The oxygen is delivered at normal/ambient air pressure.

Henry's Law says that the amount of molecular oxygen (O2) dissolved in a solution (blood and/or tissue) is directly proportional to its partial pressure. Using hyperbaric conditions greatly increases the amount of oxygen available. For example, at sea level, the plasma oxygen concentration is 3 mL/L. If you increase the pressure to 3 atmospheres, dissolved oxygen approaches 60 ml/L of O2. This is approximately the amount of O2 needed to supply the resting oxygen requirement of many tissues, even without the contribution of oxygen carried by hemoglobin.

The Undersea & Hyperbaric Medical Society (UHMS) defines hyperbaric oxygen as "an intervention in which an individual breathes near 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure (1 atmosphere absolute, or ATA). For clinical purposes, the pressure must equal or exceed 1.4 ATA while breathing near 100% oxygen."

HBOT is given in two settings: monoplace or Multiple. A monoplace chamber holds a single patient and the entire chamber is pressurized with 100% oxygen. The patient directly breathes the chamber oxygen. This type of chamber is most appropriate for clinically stable patients with chronic medical conditions. Multiple chambers can hold two or more people. It is pressurized with compressed air while patients breathe 100% oxygen via masks, head hoods, or endotracheal tubes. This allows for closer monitoring of critically ill patients.

After a review of the available scientific evidence, the UHMS published the document Hyperbaric Oxygen Therapy Recommendations (13th Edition) with 14 documented indications for HBOT. They include:

1. Air or gas embolism.
2. Carbon monoxide poisoning.
3. Clostridial myositis and myonecrosis (Gas Gangrene).
4. Crush injury, compartment syndrome and other acute traumatic ischemias.
5. Decompression sickness.
6. Arterial insufficiencies.
7. Severe anemia.
8. Intracranial abscess.
9. Necrotizing soft tissue infections.
10. Osteomyelitis (refractory).
11. Delayed radiation injury (soft tissue and bony necrosis).
12. Compromised grafts and flaps.
13. Acute thermal burn injury.
14. Idiopathic sudden sensorineural hearing loss.

Air embolism, carbon monoxide poisoning, and decompression sickness (commonly known as "the bends") are indications for HBOT as a primary treatment. Decompression sickness is a condition caused by a rapid decrease in the pressure that surrounds you, of either air or water. It most commonly occurs in scuba or deep-sea divers but can also occur in high altitude or unpressurized air travel. The compressed air divers use contains both oxygen and nitrogen. As you dive deeper, the amount of oxygen and nitrogen in the blood increases as the pressure increases. The oxygen is used by the body, but the extra nitrogen remains in the blood. If you come up to the surface too quickly, the rapid decrease in pressure causes the nitrogen to come out of the blood and form bubbles in the tissues. These bubbles can cause severe joint and bone pain associated with the condition.

Boyles' Law states that the volume of a gas is inversely proportional to the pressure exerted on it. Using HBOT in decompression sickness significantly decreases the volume of the nitrogen bubbles and increases the amount of oxygen that can be metabolized by the tissues. A similar thing occurs when HBOT is used in the treatment of an air embolus.

Carbon monoxide (CO) poisoning is another example of HBOT used as a primary treatment. Carbon monoxide binds to hemoglobin much more strongly than to oxygen. The presence of high levels of CO in the blood leads to a marked decrease in oxygen-carrying ability and oxygen release to the tissues. HBOT brings higher oxygen levels to the blood and significantly decreases the half-life of carboxyhemoglobin.

HBOT can also be used as adjuvant therapy in the treatment of several disorders. A review by Leach et al. lists some of the cellular and biochemical benefits of hyperbaric oxygen:

• Promotes angiogenesis and wound healing.
• Kills certain anaerobes.
• Prevents growth of species such as pseudomonas.
• Prevents production of clostridial alpha-toxin.
• Restores neutrophil-mediated bacterial killing in previously hypoxic tissues.
• Reduces leucocyte adhesion in reperfusion injury, preventing release of proteases and free radicals which cause vasoconstriction and cellular damage

These properties have led to the use of HBOT as an adjuvant in promoting wound healing in situations with poorly vascularized tissue, in necrotizing infections and osteomyelitis and acute thermal burns.

But any search of the internet will find page after page of HBOT being promoted for use in a multitude of conditions for which scientific evidence of efficacy is lacking. The FDA (which approves HBOT equipment) is concerned that some claims made by treatment centers using HBOT may give consumers a wrong impression that could ultimately endanger their health.

An FDA article called Hyperbaric Oxygen: Don't Be Misled warns, "Patients may be unaware that the safety and effectiveness of HBOT have not been established for these diseases and conditions, including HIV/AIDS, Alzheimer's disease, asthma, Bell's palsy, brain injuries, cerebral palsy, depression, heart disease, hepatitis, migraines, multiple sclerosis, Parkinson's disease, spinal cord injuries, sports injuries, and stroke."

What are the Risks of HBOT?

Patients receiving HBOT are at risk of suffering an injury that can be mild (such as sinus pain, ear pressure, painful joints) or serious (such as paralysis, air embolism). Since hyperbaric chambers are oxygen-rich environments, there is also a risk of fire.

The only absolute contraindication to HBOT is untreated pneumothorax. Relative contraindications include obstructive lung disease (increased oxygen may decrease respiratory drive in these patients), sinus infection or recent ear or thoracic surgery.

A few studies have been done or are underway to evaluate whether HBOT has any effect on patients with depression, Parkinson's disease, autism spectrum, traumatic brain injury, and fibromyalgia, but results have been mixed, and FDA has determined that there is not enough evidence to recommend HBOT for these disorders at this time.

Clinical trials can be found in clinical trials. gov.

Michele R. Berman, MD, and Mark S. Boguski, MD, Ph.D., are a wife and husband team of physicians who have trained and taught at some of the top medical schools in the country, including Harvard, Johns Hopkins, and Washington University in St. Louis. Their mission is both a journalistic and educational one: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.

Hyperbaric Application to COVID-19 Pulmonary Infection

In the midst of the coronavirus epidemic/pandemic, it bears remembering the application of hyperbaric oxygen therapy to the last major pandemic that impacted the United States in 1918, the Spanish Flu Pandemic.  Death was primarily by pulmonary infection and its attendant hypoxemia and respiratory failure. The first application of hyperbaric medicine to a Spanish Flu victim was likely also the first application to a human being in the United States. In 1918 Dr. Orval Cunningham of Kansas City was brought a dying friend of a fellow physician.  The patient was moribund and blue.  Before Cunningham could perform his planned animal experiments he was asked to treat this dying patient. With just a one-hour treatment with compressed air at 1.68 atmospheres absolute, the patient experienced improvement.  Combined with additional hyperbaric treatments over the next 3 days this patient’s life was saved.  Others followed.

Today’s coronavirus’ mortality is due to pulmonary infection and respiratory failure. While there are differences between the Spanish Flu and coronavirus the primary pathology is in the lungs, the first organ of contact with hyperbaric therapy beyond the skin.  The ability of hyperbaric oxygen to penetrate inflammatory pulmonary secretions allows adequate oxygen to reach the blood while inhibiting the inflammatory process. Applied correctly, hyperbaric therapy may have utility in coronavirus patients similar to its life-saving history with the Spanish Flu.

In the last 24 hours, two new pieces of evidence have surfaced supporting Dr. Harch’s original proposal of 3/3/2020 to consider HBOT for the treatment of coronavirus infection.

Today, the publication of a retrospective analysis of lung CT scans on 121 patients infected with coronavirus in four Chinese provinces was announced. The CT scans showed progressive air space disease that radiologically depicted the diffusion barrier to oxygen that Dr. Harch suggested was similar to the lung pathology in Spanish Flu victims of 1918.

Simultaneously, Dr. Harch’s research assistant found evidence of the successful treatment of a severe case of coronavirus infection in Wuhan, China. The patient was treated through the critical period with a similar number of daily hyperbaric treatments that Dr. Orval Cunningham used on his Spanish Flu cases in 1918. This Chinese patient managed to successfully traverse the critically ill period and was no longer in jeopardy.

This successful treatment, however, is a double-edged sword. Infection transmission is facilitated in hyperbaric chamber environments. Look no further than saturation diving conditions, where strict sanitation and infection control measures are industry standards. Coronavirus-infected patients should only be treated by medical professionals who are trained, experienced, and equipped to provide HBOT treatment under strict infection mitigated conditions.

Beware of clinics and opportunists advertising to “boost immunity” or treat coronavirus patients in portable chambers or other chambers in freestanding centers without qualified healthcare professionals trained, experienced and equipped to practice with strict infection control. This type of opportunism has beset the hyperbaric medicine field for centuries. Opportunists like this are responsible for the disparagement of hyperbaric therapy that has overshadowed the science and clinical wonder of this therapy. Hyperbaric clinics that are not equipped to treat coronavirus will act as vectors to amplify disease dissemination. Beware.