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Yesterday there was a news report on one of the clinical trials using hyperbaric oxygen therapy to reduce the need for intubation in patients with severe COVID-19 pneumonia.

There is nothing magic about a hyperbaric chamber for COVID-19 related hypoxia. It is simply a very efficient method of oxygen delivery.

Normally the body is very content with breathing only 21% oxygen (with the rest mostly being Nitrogen). That’s because when the lungs are healthy, the oxygen is delivered very efficiently to the blood. The hemoglobin in the red cells grabs the oxygen diffusing from the lung air sacs and delivers it to the body tissues. In a healthy person, the percentage of hemoglobin molecules that have oxygen attached to them is >95%. That is an “oxygen saturation” of 95% or greater. This is a very efficient system.

When a patient has pneumonia, the air sacs of the lung are inflamed and it is hard for oxygen to diffuse into the blood past this barrier. As a result, the oxygen level in the blood drops, called “hypoxia.” The solution is to breathe MORE molecules of oxygen to overcome the barrier in the lung. This means breathing more than the 21% Oxygen available in room air.

There are many ways to provide supplemental oxygen, and because too much oxygen is poisonous it is not good to give more oxygen than needed. The oxygen saturation in the blood is used to guide the way additional oxygen is provided.

Hyperbaric oxygen therapy (HBOT) is one of many ways to provide extra oxygen to the blood. I have created a very simple schematic to show this. HBOT uses the physics of gas laws to dramatically increase the oxygen in the blood. Unfortunately, folks who did not take basic science in school do not understand these concepts. Oxygen is not made by a pharmaceutical company, or there would be funding for the COVID-19 clinical stuides (and I could get better graphics than the ones I created below right before my clinic started this morning).

Breathing Air in a hospital room: Air is 21% Oxygen, the rest is Nitrogen. Total atmospheric pressure = 760 mmHg. Pretend there are 608 blue Nitrogen molecules and 152 green Oxygen molecules in the room.

HBOT and COVID-19

Breathing 50% oxygen in a hospital room with a face mask. Pretend there are 380 blue Nitrogen molecules and 380 green Oxygen molecules.

HBOT Treatment for COVID-19

Breathing 100% Oxygen in a hospital room with a face mask. Pretend there are actually 760 green oxygen molecules.

Hyperbaric Oxygen Therapy for COVID-19

Breathing 100% Oxygen in a helmet. Actually, I am not sure what the total number of Oxygen molecules would be, but the idea is that you can get more than 760 Oxygen molecules in a helmet.

Hyperbaric Oxygen Therapy for COVID-19

Breathing 100% Oxygen in a hyperbaric chamber pressurized to 2 times atmospheric pressure. Pretend there are actually 1,520 Oxygen molecules.

There are a lot of treatments being tried for COVID-19 pneumonia, many of which have promise, although we won’t have enough data for months (or even years) to determine which ones really make a difference. Most potential COVID-19 treatments are drugs, but I’ve even read about the use of lung radiation!

What many of those treatments do have – giving them an advantage over hyperbaric oxygen and other non-drug therapies – is funding from pharmaceutical companies that stand to make a fortune off drugs or vaccines that end up working. I am GLAD that drug companies fund this research and grateful for the drugs they develop or expand the use of – but there’s no source of funding to evaluate treatments that are NOT made by a pharmaceutical company – like Oxygen.

That’s the eternal criticism of HBOT – that good clinical trial data are lacking to support it, but exactly WHERE would the money come from to study the use of oxygen? And what is a more logical treatment for hypoxia than OXYGEN?


Dr. Fife sees patients at the CHI St. Luke's Hospital Wound Clinic in The Woodlands, Texas. For an appointment call (936) 266-2150.



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