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Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls.

Identifieur interne : 000000 ( Main/Exploration ); suivant : 000001

Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls.

Auteurs : Scott A. Gorenstein [États-Unis] ; Michael L. Castellano [États-Unis] ; Eric S. Slone [États-Unis] ; Brian Gillette [États-Unis] ; Helen Liu [États-Unis] ; Cindy Alsamarraie [États-Unis] ; Alan M. Jacobson [États-Unis] ; Stephen P. Wall [États-Unis] ; Samrachana Adhikari [États-Unis] ; Jordan L. Swartz [États-Unis] ; Jenica J S. Mcmullen [États-Unis] ; Marcela Osorio [États-Unis] ; Christian A. Koziatek [États-Unis] ; David C. Lee [États-Unis]

Source :

RBID : pubmed:32931666

Descripteurs français

English descriptors

Abstract

Objective

Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress.

Methods

This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation.

Results

We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046).

Conclusion

Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multicenter randomized control trial.


PubMed: 32931666


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<name sortKey="Swartz, Jordan L" sort="Swartz, Jordan L" uniqKey="Swartz J" first="Jordan L" last="Swartz">Jordan L. Swartz</name>
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<name sortKey="Mcmullen, Jenica J S" sort="Mcmullen, Jenica J S" uniqKey="Mcmullen J" first="Jenica J S" last="Mcmullen">Jenica J S. Mcmullen</name>
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<name sortKey="Lee, David C" sort="Lee, David C" uniqKey="Lee D" first="David C" last="Lee">David C. Lee</name>
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<keywords scheme="KwdEn" xml:lang="en">
<term>Adult (MeSH)</term>
<term>Aged (MeSH)</term>
<term>Atmospheric Pressure (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>Case-Control Studies (MeSH)</term>
<term>Coronavirus Infections (complications)</term>
<term>Coronavirus Infections (mortality)</term>
<term>Coronavirus Infections (therapy)</term>
<term>Female (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Hyperbaric Oxygenation (adverse effects)</term>
<term>Hyperbaric Oxygenation (methods)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (complications)</term>
<term>Pneumonia, Viral (mortality)</term>
<term>Pneumonia, Viral (therapy)</term>
<term>Propensity Score (MeSH)</term>
<term>Respiration, Artificial (mortality)</term>
<term>Respiratory Distress Syndrome, Adult (etiology)</term>
<term>Respiratory Distress Syndrome, Adult (mortality)</term>
<term>Respiratory Distress Syndrome, Adult (therapy)</term>
<term>Risk Factors (MeSH)</term>
<term>Safety (MeSH)</term>
<term>Survival Analysis (MeSH)</term>
<term>Time Factors (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr">
<term>Adulte (MeSH)</term>
<term>Adulte d'âge moyen (MeSH)</term>
<term>Analyse de survie (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>Facteurs de risque (MeSH)</term>
<term>Facteurs temps (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Infections à coronavirus (complications)</term>
<term>Infections à coronavirus (mortalité)</term>
<term>Infections à coronavirus (thérapie)</term>
<term>Mâle (MeSH)</term>
<term>Oxygénation hyperbare (effets indésirables)</term>
<term>Oxygénation hyperbare (méthodes)</term>
<term>Pandémies (MeSH)</term>
<term>Pneumopathie virale (complications)</term>
<term>Pneumopathie virale (mortalité)</term>
<term>Pneumopathie virale (thérapie)</term>
<term>Pression atmosphérique (MeSH)</term>
<term>Résultat thérapeutique (MeSH)</term>
<term>Score de propension (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Syndrome de détresse respiratoire de l'adulte (mortalité)</term>
<term>Syndrome de détresse respiratoire de l'adulte (thérapie)</term>
<term>Syndrome de détresse respiratoire de l'adulte (étiologie)</term>
<term>Sécurité (MeSH)</term>
<term>Ventilation artificielle (mortalité)</term>
<term>Études cas-témoins (MeSH)</term>
</keywords>
<keywords scheme="MESH" qualifier="adverse effects" xml:lang="en">
<term>Hyperbaric Oxygenation</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en">
<term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr">
<term>Infections à coronavirus</term>
<term>Oxygénation hyperbare</term>
<term>Pneumopathie virale</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en">
<term>Respiratory Distress Syndrome, Adult</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en">
<term>Hyperbaric Oxygenation</term>
</keywords>
<keywords scheme="MESH" qualifier="mortality" xml:lang="en">
<term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
<term>Respiration, Artificial</term>
<term>Respiratory Distress Syndrome, Adult</term>
</keywords>
<keywords scheme="MESH" qualifier="mortalité" xml:lang="fr">
<term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
<term>Syndrome de détresse respiratoire de l'adulte</term>
<term>Ventilation artificielle</term>
</keywords>
<keywords scheme="MESH" qualifier="méthodes" xml:lang="fr">
<term>Oxygénation hyperbare</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en">
<term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
<term>Respiratory Distress Syndrome, Adult</term>
</keywords>
<keywords scheme="MESH" qualifier="thérapie" xml:lang="fr">
<term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
<term>Syndrome de détresse respiratoire de l'adulte</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr">
<term>Syndrome de détresse respiratoire de l'adulte</term>
</keywords>
<keywords scheme="MESH" xml:lang="en">
<term>Adult</term>
<term>Aged</term>
<term>Atmospheric Pressure</term>
<term>Betacoronavirus</term>
<term>Case-Control Studies</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Pandemics</term>
<term>Propensity Score</term>
<term>Risk Factors</term>
<term>Safety</term>
<term>Survival Analysis</term>
<term>Time Factors</term>
<term>Treatment Outcome</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Analyse de survie</term>
<term>Betacoronavirus</term>
<term>Facteurs de risque</term>
<term>Facteurs temps</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Pandémies</term>
<term>Pression atmosphérique</term>
<term>Résultat thérapeutique</term>
<term>Score de propension</term>
<term>Sujet âgé</term>
<term>Sécurité</term>
<term>Études cas-témoins</term>
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<front>
<div type="abstract" xml:lang="en">
<p>
<b>Objective</b>
</p>
<p>Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>Methods</b>
</p>
<p>This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation.</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>Results</b>
</p>
<p>We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046).</p>
</div>
<div type="abstract" xml:lang="en">
<p>
<b>Conclusion</b>
</p>
<p>Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multicenter randomized control trial.</p>
</div>
</front>
</TEI>
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<MedlineCitation Status="MEDLINE" Owner="NLM">
<PMID Version="1">32931666</PMID>
<DateCompleted>
<Year>2020</Year>
<Month>09</Month>
<Day>24</Day>
</DateCompleted>
<DateRevised>
<Year>2020</Year>
<Month>09</Month>
<Day>24</Day>
</DateRevised>
<Article PubModel="Print">
<Journal>
<ISSN IssnType="Print">1066-2936</ISSN>
<JournalIssue CitedMedium="Internet">
<Volume>47</Volume>
<Issue>3</Issue>
<PubDate>
<MedlineDate>2020 Third Quarter</MedlineDate>
</PubDate>
</JournalIssue>
<Title>Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc</Title>
<ISOAbbreviation>Undersea Hyperb Med</ISOAbbreviation>
</Journal>
<ArticleTitle>Hyperbaric oxygen therapy for COVID-19 patients with respiratory distress: treated cases versus propensity-matched controls.</ArticleTitle>
<Pagination>
<MedlinePgn>405-413</MedlinePgn>
</Pagination>
<Abstract>
<AbstractText Label="Objective" NlmCategory="UNASSIGNED">Given the high mortality and prolonged duration of mechanical ventilation of COVID-19 patients, we evaluated the safety and efficacy of hyperbaric oxygen for COVID-19 patients with respiratory distress.</AbstractText>
<AbstractText Label="Methods" NlmCategory="UNASSIGNED">This is a single-center clinical trial of COVID-19 patients at NYU Winthrop Hospital from March 31 to April 28, 2020. Patients in this trial received hyperbaric oxygen therapy at 2.0 atmospheres of pressure in monoplace hyperbaric chambers for 90 minutes daily for a maximum of five total treatments. Controls were identified using propensity score matching among COVID-19 patients admitted during the same time period. Using competing-risks survival regression, we analyzed our primary outcome of inpatient mortality and secondary outcome of mechanical ventilation.</AbstractText>
<AbstractText Label="Results" NlmCategory="UNASSIGNED">We treated 20 COVID-19 patients with hyperbaric oxygen. Ages ranged from 30 to 79 years with an oxygen requirement ranging from 2 to 15 liters on hospital days 0 to 14. Of these 20 patients, two (10%) were intubated and died, and none remain hospitalized. Among 60 propensity-matched controls based on age, sex, body mass index, coronary artery disease, troponin, D-dimer, hospital day, and oxygen requirement, 18 (30%) were intubated, 13 (22%) have died, and three (5%) remain hospitalized (with one still requiring mechanical ventilation). Assuming no further deaths among controls, we estimate that the adjusted subdistribution hazard ratios were 0.37 for inpatient mortality (p=0.14) and 0.26 for mechanical ventilation (p=0.046).</AbstractText>
<AbstractText Label="Conclusion" NlmCategory="UNASSIGNED">Though limited by its study design, our results demonstrate the safety of hyperbaric oxygen among COVID-19 patients and strongly suggests the need for a well-designed, multicenter randomized control trial.</AbstractText>
<CopyrightInformation>Copyright© Undersea and Hyperbaric Medical Society.</CopyrightInformation>
</Abstract>
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<Author ValidYN="Y">
<LastName>Gorenstein</LastName>
<ForeName>Scott A</ForeName>
<Initials>SA</Initials>
<AffiliationInfo>
<Affiliation>Division of Wound Care, Department of Surgery, NYU Winthrop Hospital, New York, NY, U.S.</Affiliation>
</AffiliationInfo>
<AffiliationInfo>
<Affiliation>NYU Long Island School of Medicine, New York, NY, U.S.</Affiliation>
</AffiliationInfo>
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<ForeName>Michael L</ForeName>
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<Affiliation>Department of Population Health, NYU Grossman School of Medicine, New York, NY, U.S.</Affiliation>
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<LastName>Adhikari</LastName>
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<Affiliation>Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, U.S.</Affiliation>
</AffiliationInfo>
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<LastName>Lee</LastName>
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<Affiliation>Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY, U.S.</Affiliation>
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<AffiliationInfo>
<Affiliation>Department of Population Health, NYU Grossman School of Medicine, New York, NY, U.S.</Affiliation>
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<QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName>
<QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="Y">therapy</QualifierName>
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<DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName>
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<MeshHeading>
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<QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName>
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<Keyword MajorTopicYN="N"> COVID-19 </Keyword>
<Keyword MajorTopicYN="N"> hyperbaric oxygen therapy </Keyword>
<Keyword MajorTopicYN="N"> infectious diseases </Keyword>
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<CoiStatement>The authors of this paper declare no conflicts of interest exist with this submission.</CoiStatement>
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<name sortKey="Adhikari, Samrachana" sort="Adhikari, Samrachana" uniqKey="Adhikari S" first="Samrachana" last="Adhikari">Samrachana Adhikari</name>
<name sortKey="Alsamarraie, Cindy" sort="Alsamarraie, Cindy" uniqKey="Alsamarraie C" first="Cindy" last="Alsamarraie">Cindy Alsamarraie</name>
<name sortKey="Alsamarraie, Cindy" sort="Alsamarraie, Cindy" uniqKey="Alsamarraie C" first="Cindy" last="Alsamarraie">Cindy Alsamarraie</name>
<name sortKey="Castellano, Michael L" sort="Castellano, Michael L" uniqKey="Castellano M" first="Michael L" last="Castellano">Michael L. Castellano</name>
<name sortKey="Castellano, Michael L" sort="Castellano, Michael L" uniqKey="Castellano M" first="Michael L" last="Castellano">Michael L. Castellano</name>
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<name sortKey="Jacobson, Alan M" sort="Jacobson, Alan M" uniqKey="Jacobson A" first="Alan M" last="Jacobson">Alan M. Jacobson</name>
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<name sortKey="Koziatek, Christian A" sort="Koziatek, Christian A" uniqKey="Koziatek C" first="Christian A" last="Koziatek">Christian A. Koziatek</name>
<name sortKey="Lee, David C" sort="Lee, David C" uniqKey="Lee D" first="David C" last="Lee">David C. Lee</name>
<name sortKey="Lee, David C" sort="Lee, David C" uniqKey="Lee D" first="David C" last="Lee">David C. Lee</name>
<name sortKey="Liu, Helen" sort="Liu, Helen" uniqKey="Liu H" first="Helen" last="Liu">Helen Liu</name>
<name sortKey="Liu, Helen" sort="Liu, Helen" uniqKey="Liu H" first="Helen" last="Liu">Helen Liu</name>
<name sortKey="Mcmullen, Jenica J S" sort="Mcmullen, Jenica J S" uniqKey="Mcmullen J" first="Jenica J S" last="Mcmullen">Jenica J S. Mcmullen</name>
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<name sortKey="Slone, Eric S" sort="Slone, Eric S" uniqKey="Slone E" first="Eric S" last="Slone">Eric S. Slone</name>
<name sortKey="Slone, Eric S" sort="Slone, Eric S" uniqKey="Slone E" first="Eric S" last="Slone">Eric S. Slone</name>
<name sortKey="Swartz, Jordan L" sort="Swartz, Jordan L" uniqKey="Swartz J" first="Jordan L" last="Swartz">Jordan L. Swartz</name>
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<name sortKey="Wall, Stephen P" sort="Wall, Stephen P" uniqKey="Wall S" first="Stephen P" last="Wall">Stephen P. Wall</name>
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