Gorenstein Scott A, Castellano Michael L, Slone Eric S, Gillette Brian, Liu Helen, Alsamarraie Cindy, Jacobson Alan M, Wall Stephen P, Adhikari Samrachana, Swartz Jordan L, McMullen Jenica J S, Osorio Marcela, Koziatek Christian A, Lee David C
Division of Wound Care, Department of Surgery, NYU Winthrop Hospital, New York, NY, U.S.
NYU Long Island School of Medicine, New York, NY, U.S.
Undersea Hyperb Med. 2020 Third Quarter;47(3):405-413. doi: 10.22462/01.03.2020.1.
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.
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.
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).
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.
鉴于新型冠状病毒肺炎（COVID-19）患者机械通气死亡率高且持续时间长，我们评估了高压氧治疗对伴有呼吸窘迫的COVID-19患者的安全性和有效性。
这是一项于2020年3月31日至4月28日在纽约大学温思罗普医院开展的针对COVID-19患者的单中心临床试验。该试验中的患者在单人高压氧舱内接受2.0个大气压的高压氧治疗，每天治疗90分钟，最多进行5次治疗。通过倾向得分匹配在同一时期入院的COVID-19患者中确定对照组。使用竞争风险生存回归分析，我们分析了住院死亡率这一主要结局和机械通气这一次要结局。
我们用高压氧治疗了20例COVID-19患者。年龄范围为30至79岁，在住院第0至14天的吸氧需求量为2至15升。在这20例患者中，2例（10%）插管后死亡，无一例仍住院。在基于年龄、性别、体重指数、冠状动脉疾病、肌钙蛋白、D-二聚体、住院天数和吸氧需求量进行倾向得分匹配的60例对照组患者中，18例（30%）插管，13例（22%）死亡，3例（5%）仍住院（其中1例仍需要机械通气）。假设对照组无进一步死亡病例，我们估计住院死亡率的调整后亚分布风险比为0.37（p = 0.14），机械通气的调整后亚分布风险比为0.26（p = 0.046）。
尽管受研究设计限制，我们的结果证明了高压氧在COVID-19患者中的安全性，并强烈表明需要开展一项设计良好的多中心随机对照试验。
