Two thirds of neurocognitive test scores returned to the normal range after eight weeks of hyperbaric oxygen therapy (HBOT) in a patient suffering from debilitating long COVID impairment. This recovery, seen in a case managed by specialist Craig Lindsey, highlights the potential of pressurized oxygen to address the complex physiological disruptions associated with the condition.
Biological Mechanisms for Oxygenation and Repair
Proponents suggest HBOT addresses several suspected drivers of long COVID, including impaired oxygen extraction at the tissue level caused by thickened capillary membranes. By forcing more oxygen to dissolve directly into the blood, the therapy may compensate for these vascular inefficiencies. Beyond simple oxygenation, HBOT is thought to target chronic inflammation by reducing cytokine levels and stimulating new blood vessel growth.
There is also evidence that the therapy may trigger the release of growth factors, such as brain-derived neurotrophic factor, which could assist in repairing neurons damaged by neuroinflammation. This multi-pronged approach aims to stabilize malfunctioning mitochondria and reduce the blood clotting issues frequently linked to the disease.
Clinical Evidence and the Importance of Dosage
A placebo-controlled phase 2 randomized trial conducted at Shamir Medical Center in Israel involving 73 patients found lasting improvements in cognition, energy, and sleep. Participants underwent daily sessions for 40 days, with benefits persisting for at least a year in follow-up studies. However, a Swedish trial of 80 subjects showed no advantage over a placebo, likely due to a significantly lower dosage protocol of only 10 sessions over six weeks.
Effective treatment appears to require an intensive, Monday-through-Friday daily schedule. Without this frequency, the physiological benefits may not reach the threshold required for meaningful recovery. This discrepancy underscores the need for standardized protocols regarding session count and pressure levels.
Risks of Improper Selection and Unregulated Care
While HBOT is generally safe in controlled clinical settings, it is not without risk. A study in the Netherlands reported that while 56 to 63 percent of long COVID patients saw quality-of-life improvements, 13 to 19 percent experienced a deterioration in mental or physical health. Patients with postexertional malaise may be particularly vulnerable to adverse effects from the physical exertion required to breathe against high pressure for 90 minutes a day.
Unregulated "medical spas" pose additional dangers, often operating at pressures too low to be clinically effective and utilizing uncertified staff. Proper administration requires clinicians specifically trained in hyperbaric medicine to manage risks such as tissue damage from pressure differentials and fire hazards. As research continues, identifying which specific patient phenotypes—such as those with vascular dysfunction versus neuroinflammation—respond best to HBOT will be the next critical step in clinical application.
Source: Hyperbaric oxygen therapy is being explored as a long COVID treatment. Here's what the research shows
Domain: scientificamerican.com
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