I

NT RODUCT I
ON: -
COVID-19 ist he mos tr ecently di
scover
e di nfe
ctiousdi seasec aused by t he
coronavi
rusandha sbe ende claredapa ndemica ndglobal emergencybyt heWHO. I
t
i
sar e
spir
atoryt r
acti nfecti
on,t hatwasf i
rstr ecognizedi nWuha n,Chi na,in
Decembe r2019.
Ane wc or
onav i
rus,S ARS -
CoV-2,t hatsparkedar espir
a tor
ydi s
easeout breakin
Wuha n,Chinai snow apa ndemi c
.T he coronavirusdi seas
e 2019 ( COVI D-
19)
outbreakwasre port
edi nDec ember2019, andtheWor l
dHea lt
hOr gani
zation(WHO)
declar
editapa ndemicon11Ma rch2020.
AsofApr i
l102020Ov er1. 49mi l
l
ioninfect
ionsa rec onf
ir
me dina tl ea
st184
countri
esandte rr
it
ories,incl
udingmor et
han90, 000de aths

E
tiology
S
ev ereacuteres
pir
atorysyndr
omec orona
vir
us2( SARS-
CoV-
2),aposit
ives
ens
e,
s
inglest
randedRNAvirusha
v i
ngcl
osegenet
icsi
mil
ari
tytobatc
orona
vir
uses

Pathophysiol
og y
Spikesurfaceg lyc
opr oteinoft hev irusbindst ot hehostv i
ar ec
eptorbinding
doma i
nsoft hea ngiotens i
nc onvert
inge nzyme2( ACE 2)
,whichismos tabundantin
typeIIal
veolarcell
s( JVirol2020;94:e00127-20)
AfteraS ARS-CoV-2a t
tache stoat a r
g etcel
l,thevir
ionrele
ase sRNAi nt
ot hec el
l
,
i
niti
ati
ngr epl
icati
onoft hev i
ruswhi chfurtherdis
seminatest
oi nfec
tmor ecell
s(Cel
l
2020Ma r4[ Epuba hea dofpr int
])
SARS-CoV-2pr oducess everalvir
ulencef ac
torsthatpromotesheddingofne wvir
ions
fr
omhos tc el
lsandinhi biti
mmuner esponse
Thel ungsarema rv
elousl
yc omplex“ ma c
hines”tha tt
ransfe
rox ygenf romt hea irwe
breatheintoredbloodc el
ls(RBCs )thatcanthenmov et hatoxyge nthroug houtt he
bodyt othetis
suesthatne edi t
.Att hesamet i
me,t heRBCsmov ec arbondi oxide
(CO2) ,whichisawa st
epr oduc t
,f r
om thet issuesba cktot hel ung swhe rei tis
exhaled.Whe ns omethi
ngg oeswr ongandt hebodyi snotg e
ttinge noug hox ygen,
wet endt ofi
rstsuspectthel ungs.Foronet hing,becausethel ungsbeha v
el ike
ma chines,wecanmor ee a
s i
lyunde rst
andhowt heywor k.Ther e
s tofthepr oce ssof
mov ingox yg
ena ndCO2i sa llchemi s
try
,s otakesmor eeffor
tt ot easeoutwha t’
s
actuallyg
oingon.
He mog l
obi
ni sthemol eculeinsi
dey ourredbloodc el
l
s( RBCs
)thatc a
rri
es
oxygen.TheRBCspickupoxy geninthelungsandcar
ryita r
oundthebody,re
leasi
ng
i
ttot hecell
sandtis
suesthatnee dit
.Thenor maloxy
g enrangeforahea
lthpati
ent
i
s95– 100%,whichme anst
ha t95–100%oft hehemoglobininyourbl
oodhasoxygen
boundt oit
.Bel
owa bout89%, thebodystar
tstohavetroublef
romal a
ckofoxygen
Pack
a g
edi ns
ideredbloodcell
s,hemoglobinisapr oteincompr i
si
ngfourglobula
r
prot
einsubunit
s(cal
l
edg l
obi
ns),eac
hofwhi chc ar
ri
esa ne mbeddedhemeg roup.A
hemeg roupisma deofa ni
roniona nda nothercompoundc al
ledporphyr
in(see
fi
gur
ebel ow foradi agr
am ofhe moglobin’
ss tr
ucture).Throughther ev
er s
ibl
e
bi
ndingofoxygentotheir
onioninhe meg r
oups ,r
edbl oodcell
scanpi
ckupox ygen
i
n t he l ung s a nd de liv
er i t t o t he r est of t he body .
F
igur
e—Themol
ecul
ars
truc
tur
eofhemog
lobi
n.

Thepa ti
ent
sa r
edesat
ura
tedbecausetheyaretr
ulyhypox
emi
c(l
ow ar
ter
ial
part
ialpres
sureofoxyg
eni nthebloodst
ream).Thedegr
eeofdesa
tur
ati
onis
complet
elyexpl
ai
nedbyt
hedegreeofar
ter
ialhy
poxemi
a.
Thea r
ter
ialhypoxemia(hyp=l ow,ox=ox yge
n,emia=i nblood)isduet othe
fac
tthatthelungsa rei
nfecteda ndse ver
elydamaged,andsot heox ygencannot
tr
avelacr
osstheal
v eol
armembr a
net oloadontohemog l
obini
nre dbloodce l
l
s.The
hemoglobi
nitsel
fi sperfec
tlyf i
ne.T heox yge
ns impl
yc an’tdiff
usea crossthe
damagedlungsurf
a c
e.Thereforethebl oodcomingoutofthelungsha snoox yge
n.
Thi
sbloodwillbepumpedt ot her es
toft hebody.Sothebodydoe snotr ecei
ve
enoughoxyge
nbe causethelungsa r
etooda magedtoabsorboxygen.
I
nc uba ti
onpe riod
Theex a ctinc uba ti
onpe r
iodi snotk nown. Itispre s
umedt obebet we e n2to14da ys
afte r
expos ur e ,withmos tc asesoc cur ri
ngwi t hin5da ysa ft
erexposure[ 8,9, and10].
Thes pe ctrumofi llnes ssever i
ty
Mos ti nfec t
ionsa res elflimiting .COVI D- 19t endst ocausemor es evereill
nessin
elder l
y
popul a tionori npa ti
e ntswi thunder lyingme dicalprobl
ems .Aspe rther eportfr
om
Chi nes e
cent erf ordi seasec ontrola ndpr event iont ha tincl
udeda ppr oxima t
ely44,500
conf i
rme d
I
nf e c
tionswi tha ne stima ti
onofdi sea s
es everit
y[ 11]
•Mi ldi ll
nes swa sr e portedi n81%pa tie nts
•S eve reill
nes s(Hy pox emi a,>50%l ungi nvolveme ntonima gi
ngwi thin24t o48
hour s)in14%
•Cr iticalDi sea se( Re spiratoryf ail
ur e,s hoc k,mul t
i-
organdy sfunc ti
ons yndrome)
wa s
re por tedi n5per c ent
•Ov e ra l
lcas efata l
ityr atewa sbet we en2. 3t o5%
gea f
fe cted
•Mos t l
ymi ddl ea ge d( >30y ea rs)a ndel derly.
•S ympt oma t
icinf ect i
oni nc hildre na ppe ar
st obeunc ommon,a ndwhe nitoccurs
,
i
ti s
us ua l
lymi l
d[ 42]
Clinical Present ation
I
nas tudyde scribing1099pa ti
e ntswi t
hCOVI D-19pne umoniainWuha n, t
hemos t
c ommonc l
inica lf
e aturesa ttheons etofill
nesswe r
e:[41]
•F ev eri n88%
•F atiguei n38%
•Dr yc oug hin67%
•My a lgiasin14. 9%
•Dy spne ai n18. 7%
Pne umoni aa ppea rst obet hemos tc ommona nds ever
ema ni
festa t
ionofi nfec
ti
on.
I
nt hisg roupofpa t i
ent sbr eathingdi ff
ic ult
yde v el
opeda f
terame di a
noff ivedaysof
i
llne ss.
Ac uter e spir
a torydi stresss yndr omede v elopedi n3.4%ofpa tie
nts.
Othe rsy mpt oms
•He ada c he
•Sor et hr oa t
•Rhinor rhea
•Ga stroint e sti
na lsy mpt oms
About80%ofc onf irme dCOVI D-19c asessufferfr
omonl ymildtomode ratedisease
and
nearly13%ha ves ev eredi s
ease(dy spne a,r
e s
pirat
oryfr
equency≥30/minute,blood
oxygens atur ation≤ 93%,Pa O2/FiO2r ati
o< 300,and/orlunginfi
l
tra
tes> 50%oft he
l
ung
fi
eldwi thi n24- 48hour s
).
Cri
ticali ll
ne s
s ( re spi
ratory fa i
lure, s epti
c s hock,a nd/or mul t
iple or g
a n
dysfunc tion/ f a
ilure)
i
snot e di nonl yinl es sthan6%ofc a ses.
Diagnos is
Nasopha ry ng eals wa bi sr ecommende df ort hespeci
men;or opharyngeals wab,
sputum a nd br onc hoa l
veolarla vag e ma ybe us eda lt
ernati
vel
y( CDC:I nter
im
Guideline sf orCol l
ec ti
ng,Ha ndl
ing ,andT esti
ngCl i
nic
alSpeci
mensf r
omPe rs
onsf or
Corona v i
r usDi s
ea se2019( COVID- 19)
Definitedi a g nosisisba s
e donde tec t
ionofv ir
alRNAbyr ealt
imeRT -
PCR
Labora tor yMe t
aa na l
y s
isdata:
Decrea seda lbumi n
HighCr ea c ti
v epr otein
Highla cta tedehy drog enase(LDH)
Lymphopeni a
Highe ryt hr oc yt
es ediment ati
onr ate( ESR)
Radiol
ogydescr
ipt
ion
Groundglas
sopa ci
ti
es,c
raz
ypavingpat
ter
nandc
ons
oli
dat
ioni
nbi
l
ater
all
obesa
re
commonf i
ndings
TheseCTfi
ndingspeak10daysa
fterons
et

LABORAT ORYF I
NDI NGS
Whi teBl oodCel l Count
•Whi tebl oodc ellc ountc anv a ry. I
tdoesnotpr ov i
dea c
c ura t
ei nforma t i
ona bout
COVI D- 19. [40]
•L euk ope nia ,leuk oc y
tosis
,a ndl y mphope niaha v ebe enr e ported.
•L ymphope niai smor ec ommon, see ni nmor etha n80%ofpa tient s[40]
• Mi l
dt hromboc y topeniai sc ommonl ys ee n.Howe vert hromboc ytope ni
ai s
cons ide re d
a sapoorpr og nos t
ics ign.[
40, 41]
I
NF LAMMAT ORYMARKE RS
Ser umPr ocalc i
toni n
•S erum pr oca lcitonini sof tennor ma la tt het imeofa dmi ss i
on;howev erit
i
nc rea sesi n
pa tient swhor equi r eICUc are. Inones t udyhi ghD- Dime ra ndl ymphope niaa reasso
c i
a tedwi thpoorpr og nosis
.[40, 41]
C-r eac tivepr ote in( CRP)
•COVI D- 19i ncr ea se sCRP. Thiss e emst ot r
a ckwi thdi seas es everitya ndpr og nosis.
Inpa tient ssuf f
er ingf r
omwi ths e ve rer es piratoryf ail
urewi thanor ma lCRPl ev ela
n
a l
ter na ti
v edi agnos isshoulda lwa ysbes oug ht .[
40, 41]
Pa ti
ent swhomee tt hec rit
eri
af ors us pec tc ase s,asdi scusseda bov e, s
houl dunder go
testing f orS ARS -CoV- 2a nd a lsor es pirator ypa thog ens .Re spiratorys pe ci
me n
collect i
on
fromt heuppera ndi npa r
ti
cula rl owerr es pira t
or yt ractshoul dbepe rfor medunde r
strict
airbor nei nfe cti
onc ontrolpr ec aut i
ons( 25) .Pr efer ablyt he s
es ampl ess houl dbe
obt aine da s
ea rl
ya ss ympt omons et,si
ncei ty ieldshi g he rv i
rusc onc entra ti
ons .
SPE CT RUMOFDI SE AS E:-
Sev ereDi sea se( 14%)
•Re spira toryr ate> 30/ mi n
•S Po2-<93%
•Pa O2/ F iO2< 300
•L ungi nfiltr
a tes> 50%wi t
hin24-48hour s
Criticallyill(5%)
•Re spira toryf ailure( needofme cha ni c
a l ventilation)
•S e ptics hoc k
•MODS
Prog nos t i
cf actor s
Risk sofa cuter e spir atorydistres ss y ndr omede v elopmenti ncludea ge( > 65y ears)
,
under l
y ingdi s eas es( di
abe t
esmel litus)a nds econda ryinfe cti
on( JAMAI nte rnMed
2020Ma r13[ Epuba hea dofpr int],I ntens iveCa reMe d2020Ma r3[ Epuba he adof
print ]
)
Ri
skf act
orsfordeatha monghos pi
tal
i
zedChi
nes
epa
tient
s,i
nor
derofs
treng
thof
ass
oc i
ati
on(Lancet2020;395:
1054)
Coronaryheartdi
sease(p<0.0001)
Hypertensi
on
Dia
be t
e s
Chroni
ck i
dneydisease
Chroni
cobs t
ructi
velungdiseas
e(p=0.047)
mec hani
smofHBOTox ygentherapy

Hy
per
bar
icOx
yge
nat
ionpot
ent
ial
rol
e

Thedi fferenc ebe twe enHBOTox y gent he rapya ndnor ma lpr e ssur eox ygent her apy
i
s ,i ng ener a l,t he us e ofhi gh pr e ssur e ox y geni nha lati
on,whi c hf ull
ya nd
subs tant iallyi mpr ov est hee ffici
enc yofox y gent r ans por t
from t heout si
det ot hewhol et iss
uec ell
s.T heme c ha nism ofHBOTi st ot ake
adv ant ag eoft hephy sica l
c ha racte ri
sticsofg a s,t oinc re aset he
pa rti
a lpr essur eoft heox ygeni nthee nv ironme ntt hr oug hal arg e
ampl itude ,a ndt or educ ethede ma ndf orox yg enex c hang ea nd
transpor tationi nt hebodyt oa chie vet hebe stox yge nt he ra pye ffec t.
Firstl
y ,mor eel f
fec tive l
yt ha nnor ma l
pr e ssureox yge ni nha la ti
ont o
ov ercomel ungt issuei nflamma ti
on.
Thedi ffus ionr atea nddi s tanc eofhi ghpr es sur eox yg e na res ev era lt i
me st ha tof
nor ma l pres s ureox yg en, whi chov ercomet heg a sex cha ng e
obs taclec aus edbyt het hi
c ke ningoft hel ungt iss uei nfla mma t
ion.
Andbec a us eoft hehi ghers olubili
t y,thea mountofox yg endi s
s olvedi nt he
bloodi ss ev er altimest ha tofa tmos phe ricox y ge n, whi cha lsof ur t
her
ov ercome st hei nflue nc eoft hebl oodc irc ulationg a sr atio.
Thea ppl ica ti
onofHBOTt oCOVI D-19pneumoni a /hy pox emi aiss uppor tedbys ound
phy siolog ya ndHenr y sL aw.
He nr y sL awi st heba sisf ort henor ma lex c ha ng eofg asesi nourl ung s.I
ts ta t
es
tha tthec onc ent rationi nal i
qui d( pulmona rybl ood)ofa ni nter facingg as(oxy ge nin
thea lve oli oft hel ung s)ispr opor t
iona l tot hepr es sur eoft hei nt erfac i
ngg as.
F i
na lox yge nupt akea ndbi ndi ngt ohe mog lobi ni npul mona r yc apillaryr edbl ood
ce l
lsi s de pe ndent on t he di ff
us ion of di ssol ve d ox y gen f rom a lveol a
r
wa l
l→pul mona ry i nte rst
itium→c a pil
lar y wa ll→bl ood pl asma →r ed bl ood c ell
membr a ne→r edbl oodc ellc ytopla sm→he mog lobi n.I nt erferenc ewi tht hispr oc es
s
ata ny poi ntr e sultsi n de crea sed ox ygen- hemog lobi n bi ndi ng .I n COVI D-19
pne umoni a pa tient st he ba rri
ert o di ff
us i
on i si nt he a lveol i( inflamma tory
ex uda te-pneumoni a)a nd i nf l
a med i nt erstiti
um.S tanda r dt hera pyi st o ex ploi
t
Henr y sL aw byi nc rea si
ngt hepr essur eofox yg eni nt hea lv eoli( inc r
ea s
ingt he
fractiona l inspi red ox y gen c onc e ntration) : na sal
cannul a →v e nti-ma sk→non- rebr eathe r ma s
k →e ndot ra che a li ntuba tion. As t he
pneumoni tisa nd hy pox emi a pr og r
es ss ta
nda r dt he rapyc a nnotpene tratet he
diffusionba rri
e rsi nt hel ung sbec aus et he ya rel i
mi tedbya mbi entpr essure .In
addi t
ion,i tc a nnott re att hea ccumul atingox yg ende bta ndi nt ens epul mona rya nd
sys t
emi ci nf l
a mma t
or yr ea ction.T he opt i
ons a ret o by pa s
st he l ung s wi th
ext rac orpor ea lme mbr aneox y gena ti
on( ECMO)ors ur mountt hel imit st odissolution
ofox y geni nt issuea ndt heba rrier
st oox yge ndiffus ionbyf urthe re x ploit
ingHenr ys
Lawwi t
hHBOTa ndi ncre as edpr essurea bov ea mbi entpr e ssur e.
Thr oug hHe nrysL aw HBOTe nha ncesmul t i
pl
es tag esi nt hea bov epr oces sby
i
nc r eas i
ng :
1)t hedi ssolv i
ngofox ygeni nt hea l
v eolarandi nflamma t
or yba rr i
er
2)t hedi ffusionr a teofox y ge n
3)t hedi ffusiondi sta
nc eofox yg en
4)t hedi ssolut i
onofox yg eni nbl oodpl asma
5)t heox ygens atura ti
onofhe mog lobininr edbl oodc ell
s
6)t hedel iver yofox yg ent ot hemi crocir
culationa ndt issue.
Thene tr esultisar ev ersa loft hedownwa rds pir
a lofCOVI D- 19pa ti
e nt s.
T hee l
e va ti
onofs y stemi cl ev el
sofox yg enwi thHBOTha sbe ent raditi
ona ll
y
mi sunde rstood i nt erms ofr espirat
ory met abol itee ffec ts wi t hat rans i
e nt
hy per ox emi at ha tdis si
pa tesonc et hepa ti
e ntlea vest hec ha mbe r
.Howev er ,for358
yea r s,a ndes pec i
all
yi nt hemode rne ra( 1960t opr e sent ),pe rma ne nta ndl ater
trophi ce ffectsofHBOTha vebee ndoc ument edwi thbot hs ing lea ndr epe t
iti
v eHBOT .
Oneoft heme c ha nis msofa cti
onwa sr e ce ntl
yel uc idateda sepi ge net i
c
modul ationt hroug hdi re ctef fectsofhy dros t
aticpr es sur ea ndhy pe roxiaofg ene
expr ession/ suppr es s
ionofov e r40% oft hepr otei n-codi ngg e nesi nt hehuma n
genome.T hel arg estc l
us te rsofupr egulate dg e nesa ret heg rowt h,r epa i
r,c ell
signa ling,a nda nt i-i
nf l
amma tor yge nes,andt hel a rges tc lus tersofdown- reg ulate d
ge ne sa ret hepr o-inflamma t
or yg ene sandt hos et ha tc ont rol pr ogrammedc ell dea th.
As ing l
eHBOTha sbee ns howni nmul t i
ples tudi est oha vedr a ma ti
cpe rsisti
ng
effe ctsondi seas epa thophy siology,e speciall
yi nf l
a mma tion,i tsubi quitousa c
ut e
form,r eper fusioni njur y( e.g.,c arbonmonox i
depoi soni ng ,nec rot i
z i
ngi nfec ti
on,
res us cit
a ti
on,a ndot her s),a nde xtremef or m ARDS ,a ndonr ever singt hel etha l
ox yg endebtf romc a
r di
a ca rres t.

Hy perbari
cox y
gen wa sa ddedt ot hec urr
e ntcompr ehens
ivetr
eat
mentbe i
ng
per f
orme datthehos pit
alforCOVI D- 19a ffect
edpa t
iets,wit
hadoseof90-120
mi nutesattr
eatmentofpresuureof1.4-1.
fi ATA.
The r ati
onal
ef ora dding thisproc e
dur ei st o hel
pc ombatthe pr
ogr
essi
ve
hypox emia(
Lowbloodox ygenlevel
s)thatCOVI D19canca use.
Hy prbari
cha sa bil
it
yt oa dd a s ubstantialsupply ofe xt
ra ox
yge
ni nt
ot he
bloods t
reamandt her
eforecanhelpdur i
ngt heseti
meofhy pox
emia.

Hypoxemiai st hek eyde t

e r
mina ntt othedet e
riora
tionofpa t
ientsseenwi t
h
COVID19.Thev i
rusa t
tack
st helung sandc a
usesinfl
amma t
ionandt hebodyha sa
dif
fi
cul
tint i
meg ett
ingenoug hoxyg entr
ansf
erredfr
omt helungsintothebody.
Thisprogress
ivehy poxemial e
adst oincr
easeinmor t
AL I
TYRAT ES.Pati
entscan
become c ri
ti
call
y RI.Att hist ime,theya r
et ypica
ll
yi nc ompe ter e
li
ance on
venti
l
atior
st ohe l
p,rest
oreox ygenl ev
els
,t
ok eepthem a l
i
ve,whilethebodyfight
s
thevi
rusandr epair
sthelungda ma ge.

T
her
esol
uti
onofhy
pox
iai
sani
mpor
tantphy
siopa
thog
eni
cfa
ctori
nthe
dev elopme ntoft hedi sea se , wha tDr .Cunni ng ahndi dnotk nowa tt he
ti
mei st hatHBOTnotonl yc ont ribut e stoox yg ena tingt issuesa tt he
pulmona r
ya nds y stemi cl e vel .
Hy per oxiaa l
soha sa ni mpor t anta nti-i
nfla mma toryef fec t
.
HBOTr educ est hepr oduc tiona ndr e l
ea seofpr o-inf l
a mma tor yc ytok ines
byne utrophi l
sa ndmonoc yte s
Studi esr eveal thee ffectsofhy pe rba ri
cox ygena ti
ononc ytok ine
produc ti
on( Al Wa iliNS ,2006) .T hist he r
a pyi nc rea sesF GFpr oduc tion
andc ollagens ynt he sisa nddec rea sesi nterleuk in1( I
L -
1) ,inte rleuk i
n6
(I
L-6) ,andt umorne cr osisa lphaf a ctor( TNFa lpha )
.
Theef fectsoft ra ns f
or mi ngbe ta1g rowt hf act or( TGF β1)a nd
plate l
e t
-derive dg rowt hf a ctor( PDGF β)a r eg rea terwi th HBOT Regardi
ng t
he
dev elopmentofc hr oni cinf lamma t
ion, a
c tivationoft he
Toll-LikeRe cept or s(T LR)s yst emc ont ribut est ot hema inte na nceoft he
i
nfla mma toryr e spons e.
HBOTde c
re asesT LRex pr es sion, NF -k Bs i
g nalingpa thwa ysa ndt he
expr essionoft hes emol ec ula rpla tfor msi ndi ffer entt i
ss ue s(Me ngXE ,
2016, WuZ S,2018) .Fur the rmor e ,hy per ba r
icox yg e nc oul di nc reaset he
ada ptivec ell
ula rimmuner es pons eofper iphe ra lbl oodmononuc l
ea rc ell
s
i
nfec te dwi thHI V- 1v irus( acqui re di mmunode fi
c i
e nc yv irus )
, throug h
thei nc r
e aseofpr ot einst ha tc ani nhi bitv i
ral re pli
c ation( Budi a rtiR,
2018) .
Give nt heemer genc yofpa tient swi thCOVI D-19a ndt hel imi te d
extra corporea lox y ge na ti
onr esour c es, t
hehy per ba ricc ha mbe rf or
i
nfec te dpa ti
e ntss uf feringf romr espira t
or yhy pox e mi cf ailurec ouldbe
use dinc aseswi thoutpul mona ryc ont raindic ationsf orhy pe rba ric
oxy gena ti
ont her apy . I
na ddi tion, itc oulddec r ea set hei nflamma tor y
pha sea ndpe rha pss pe edupt het i
me sforr ec ov erya ndr elea seofbe ds
requi redt oa ssistt he sepa tient sdur ingt hepa ndemi c .Addi t
iona lstudi es
arenee de da ndt hes ehy pe rba ricc ha mber smus tbeope r
a tedbyqua l
ifi
ed
me dic alprofes siona lswhoc a nc a rryoutr igorousa ndr e li
abl ec ont rol of
thene edf orot hera ddi tiona l t
her a pe uti
cr equi rement sdur i
ngt he
prog re s
sionoft hedi se ase .
PROT OCOL :
-
Thec ha mbe rwa sc ompr es se dt o2. 0AT Af ora bout90mi ni nf i
rs ttrea tme ntand
60mi ni nt hef ollowed. Thede compr essi
ont oa tmos pher i
cpr e ssurewa si
n20mi n.
HBOTwoul dc ont ribut es ig nificant lyt oreduc ingmor bidity,
acce l
er ati
ngr e cov e ryt i
mesf orpa ti
e ntss ufferingf romt hepa ndemi c,
opt i
mi zinghe a l
t hr esour ce sa ndr educ i
nghea lthca rec os ts- Ar ge nti
na

Adva ntag
esofHBOT :
Fort rear
mentofpr ogr
essiv
ehy poxemiaIt hatthehig
herpressureenv i
ornment
al
wa y sgrea
te rl
e v
e l
sofox ygentopa s
sthroughthethi
ckenedandi nf
lamme dlung
ti
ssuei nt
othebl oods t
ream;there
bydirect
lytre
ati
nghypoxemi
a.
Aft
e rthefir
sts e
ssionofHy perbar
icoxyg
en, s
ymptomssuchasdyspnea(short
nessof
breath)andc hestpainwe r
er educed.
Aft
erthesecondsessi
on,theres
pir
atoryra
tede
creas
edgradua
ll
yandtheshor
tne
ss
ofbreat
h(a
ftermoveme nt)r
eli
evedsl
owly.
Byc or
rel
ati
ngt heresult
s,as i
gni
fic
antupwardtr
endofox yg
enlevel
s,dayby
day.
Andi na ddi
ti
on,L unginfl
amma ti
onwasr e
-eva
lua
tedthoughCTS canwas
si
gni
fic
antl
yimproved.

TheHy perbar
icchamber
sca nhelp“i
mprovethet r
eatmentef
fi
cie
ncy,r
e duc
et he
medicalpres
sureandtheri
skofinf
ecti
onanddecreasethemort
ali
tyr
ateofcri
ti
c a
l
pat
ients”.
Withthelimi
tedsuppl
yofventi
l
ators
,Hyper
bar
icchamber sc
anof
ferva
luabler
eli
ef.

COVI
D-19pati
entsHBOTwa sl
ikel
ytreat
ing:
 pulmonaryands ys
temichypoxia
 I
nflammation
 Otherpulmona r
ypathophysi
ologi
ctar
gets
 l
revers
ingoxygendebt
 Modulati
ngg eneexpress
ionbothacut
elyanddur
abl
y.