Long Term Outcomes of Hyperbaric Oxygen Therapy (HBOT) in Long-COVID Convincing
One-Year Data from Small Randomized Trial
Hyperbaric oxygen therapy (HBOT) is a treatment method in which patients breathe pure oxygen in a pressurized room or chamber. It’s traditionally used to treat decompression sickness, gangrene, diabetic infections, air bubbles in the circulation, non-healing wounds, and radiation injuries. HBOT also treats post-viral syndromes, which has been a hot topic recently.
What is Post-Viral Syndrome?
Post-viral syndrome, also commonly called post-viral fatigue syndrome, occurs after a person experiences a viral infection and continues to endure persistent fatigue and other symptoms well beyond the typical recovery period. Chronic fatigue syndrome (CFS), which is caused by viral infections, among other factors, may trigger, involves similar, long-lasting fatigue that isn’t relieved by rest and is aggravated by physical or mental activity.
The link between post-viral syndrome and chronic fatigue syndrome is that a viral illness could trigger the onset of CFS, especially if symptoms of extreme tiredness and other CFS-related symptoms persist for more than six months after the initial infection. Common viruses implicated include Epstein-Barr virus and human herpesvirus 6. Recently, there’s been growing attention on the potential long-term impacts of COVID-19, commonly referred to as “long COVID-19., which is a post-viral syndrome.
Symptoms shared between post-viral and chronic fatigue syndromes include:
Persistent fatigue that does not improve with rest
Muscle and joint pain
Headaches
Sore throat and swollen lymph nodes
Difficulty concentrating or “brain fog”
Sleep disturbances
Mood swings or depression
Management strategies are multimodal and may involve:
Gentle exercise that gradually increases in intensity
Cognitive behavioral therapy (CBT) to help manage the psychological impact of the illness
Medications to address pain, sleep disturbances, and other specific symptoms
Lifestyle adjustments to manage energy and prioritize activities
Because both conditions characterize a range of symptoms, treatment plans must be individualized. Patients often benefit from a multidisciplinary approach involving primary care providers, infectious disease or immunology specialists, mental health professionals, and rehabilitation experts.
HBOT has been shown to help with chronic fatigue syndrome (CFS), even though it’s somewhat controversial. Some studies and anecdotal evidence suggest that HBOT might help alleviate symptoms of CFS by enhancing tissue oxygenation and stimulating the healing process at a cellular level, which means treating the cells. HBOT restores mitochondrial function and metabolism attenuated by long COVID inside the cells.
Studies have shown improvements in symptoms, including fatigue, pain, and overall quality of life, while others have not demonstrated significant benefits. This is normal, and one modality isn’t going to help everyone. Many patients with long-term COVID-19 syndrome have seen countless doctors and have taken multitudes of vitamins, supplements, and prescription drugs. Those fortunate enough to have been referred to and completed a course of hyperbaric oxygen therapy seemed to have fared better than most.
The Study
Hadanny et al. have reported the long-term results (one year) from their original small randomized trial. The protocol comprised 40 daily sessions and five weekly sessions over two months. The HBOT protocol included breathing 100% oxygen by mask at 2 atmospheres of pressure for 90 minutes with 5-minute air breaks every 20 minutes. Control patients had HBOT without additional oxygen or pressure. The clinical improvements gained by HBOT are persistent even 1 year after the last HBOT session.
“In our previous randomized controlled trial, we documented significant improvements in cognitive, psychiatric, fatigue, sleep, and pain symptoms among long Coronavirus disease 2019 (COVID) patients who underwent hyperbaric oxygen therapy (HBOT). This longitudinal long-term follow-up included 31 patients with reported post-COVID-19 cognitive symptoms who underwent 40 daily sessions of HBOT. Participants were recruited more than one year after completing the last HBOT session. Quality of life, assessed using the short form-36 (SF-36) questionnaire, revealed that the long-term results exhibited a similar magnitude of improvement as the short-term outcomes following HBOT across most domains. Regarding sleep quality, improvements were observed … as evaluated by the brief symptom inventory-18 (BSI-18), the short-term assessment following HBOT demonstrated a large effect size, and this effect persisted at the long-term evaluation.”
Study Limitations
The sample size was only 31 patients.
Cognitive function, the primary endpoint in the original study, and brain imaging were not evaluated in the current longitudinal evaluation.
Patients who received HBOT without pure oxygen were not evaluated long-term in the original RCT.
Summary
This is an innovative study about treating a complex disease process that profoundly affects patients and their quality of life. HBOT is effective for many disease processes and even health optimization. It’s important to remember that HBOT alone is usually not the answer; the metabolic processes of what’s going on in the cells must be considered. For a great podcast on HBOT, please listen to Dr. Scott Sherr’s Hyperbaric Oxygen Therapy, Methylene Blue, and Longevity Protocols.