Can hyperbaric oxygen safely serve as an anti-inflammatory treatment for COVID-19?

INTRODUCTION: SARS-CoV-2 affects part of the innate immune response and activates an inflammatory cascade stimulating the release of cytokines and chemokines, particularly within the lung. Indeed, the inflammatory response during COVID-19 is likely the cause for the development of acute respiratory distress syndrome (ARDS). Patients with mild symptoms also show significant changes on pulmonary CT-scan suggestive of severe inflammatory involvement. HYPOTHESIS: The overall hypothesis is that HBO(2) is safe and reduces the inflammatory response in COVID-19 pneumonitis by attenuation of the innate immune system, increase hypoxia tolerance and thereby prevent organ failure and reduce mortality. EVALUATION OF THE HYPOTHESIS: HBO(2) is used in clinical practice to treat inflammatory conditions but has not been scientifically evaluated for COVID-19. Experimental and empirical data suggests that HBO(2) may reduce inflammatory response in COVID-19. However, there are concerns regarding pulmonary safety in patients with pre-existing viral pneumonitis. EMPIRICAL DATA: Anecdotes from “compassionate use” and two published case reports show promising results. CONSEQUENCES OF THE HYPOTHESIS AND DISCUSSION: Small prospective clinical trials are on the way and we are conducting a randomized clinical trial.