Introduction: Few treatments have demonstrated mortality benefit among hospitalized hypoxic COVID-19 patients except for steroids. We evaluated the use of hyperbaric oxygen therapy (HBOT) as a therapeutic intervention among hospitalized patients with a high oxygen requirement.Methods: We extracted data on patients with COVID-19 hypoxia who required at least 6 L/min oxygen supplementation, and were eligible for off-label HBOT from October 2020 to February 2021. We compared patient characteristics and used Fisher’s exact test and a survival analysis to assess the primary endpoint of inpatient death.Results: We offered HBOT to 36 patients, of which 24 received treatment and 12 did not receive treatment. Patients who did not receive treatment were significantly older (P < 0.01) and had worse baseline hypoxia (P = 0.06). Three of the 24 (13%) patients who received treatment died compared to 6 of 12 (50%) patients who did not receive treatment (RR ratio: 0.25, P = 0.04, 95% CI: 0.08 to 0.83). In the survival analysis, there was a statistically significant reduction in inpatient mortality in the treatment group (HR: 0.19, P = 0.02, 95% CI: 0.05-0.74). However, after adjusting for age and baseline hypoxia, there was no difference in inpatient mortality (hazard ratio: 0.48, P = 0.42, 95% CI: 0.08-2.86).Conclusions: The survival benefit of HBOT observed in our unadjusted analysis suggests the need to further study therapeutic benefits of HBOT in treating COVID-19 hypoxia through randomized clinical trials.
Introduction: Few treatments have demonstrated mortality benefits among hospitalized hypoxic COVID-19 patients. We evaluated the use of hyperbaric oxygen (HBO2) therapy as a therapeutic intervention among hospitalized patients with a high oxygen requirement prior to vaccine approval. Methods: We extracted data on patients with COVID-19 hypoxia who required oxygen supplementation ranging from a 6L nasal cannula up to a high-flow nasal cannula at 100% FiO2 at 60L/minute with a 100% non-rebreather mask at 15 L/minute and were eligible for off-label HBO2 therapy from October 2020 to February 2021. We followed the Monitored Emergency use of Unregistered and Investigational Interventions or (MEURI) in conjunction with the consistent re-evaluation of the protocol using the Plan-Do-Study-Act (PDSA) tool [1]. We compared patient characteristics and used Fisher’s exact test and a survival analysis to assess the primary endpoint of inpatient death. Results: HBO2 therapy was offered to 36 patients, of which 24 received treatment and 12 did not receive treatment. Patients who did not receive treatment were significantly older (p < 0.01) and had worse baseline hypoxia (p = 0.06). Three of the 24 (13%) patients who received treatment died compared to six of 12 (50%) patients who did not receive treatment (RR ratio: 0.25, p = 0.04, 95% CI: 0.08 to 0.83). In the survival analysis, there was a statistically significant reduction in inpatient mortality in the treatment group (HR: 0.19, p = 0.02, 95% CI: 0.05-0.74). However, after adjusting for age and baseline hypoxia, there was no difference in inpatient mortality (hazard ratio: 0.48, p = 0.42, 95% CI: 0.08-2.86). Conclusions: The survival benefit of HBO2 therapy observed in our unadjusted analysis suggests that there may be therapeutic benefits of HBO2 in treating COVID-19 hypoxia as an adjunct to standard care.
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