What is the role of hyperbaric oxygen therapy (HBOT) in treating viral infections, such as COVID-19?

Hyperbaric Oxygen Therapy for Viral Infections: Limited Evidence for COVID-19

Hyperbaric oxygen therapy (HBOT) is not recommended as a standard treatment for viral infections including COVID-19 due to insufficient evidence supporting its efficacy and safety in this context. Current clinical guidelines do not include HBOT in the management protocols for COVID-19 or other viral infections 1.

Current Evidence on HBOT for COVID-19

Limited Research Base

• Recent research on HBOT for COVID-19 shows preliminary but inconclusive results:
  • A 2022 study showed potential mortality benefits in hospitalized hypoxic COVID-19 patients, but after adjusting for age and baseline hypoxia, no significant difference was found 2
  • Small studies have explored HBOT for long COVID symptoms, with some showing improvements in fatigue and cognitive function 3, 4
  • A 2025 review suggests HBOT might enhance tissue oxygenation and reduce inflammation in severe COVID-19, but calls for more research 5

Established COVID-19 Management Approaches

Current evidence-based management of COVID-19 respiratory complications focuses on:

1. Oxygen Therapy Escalation Protocol 1:

   • Conventional oxygen therapy when SpO2 <92%
   • High-Flow Nasal Cannula (HFNC) for acute hypoxemic respiratory failure
   • Non-Invasive Positive Pressure Ventilation (NIPPV) if HFNC unavailable
   • Early intubation if respiratory status worsens

2. Ventilatory Support for Severe Cases 6, 1:

   • Lung-protective ventilation (4-8 mL/kg tidal volume)
   • Plateau pressures <30 cmH2O
   • Higher PEEP strategy for moderate-severe ARDS
   • Prone positioning for 12-16 hours daily

3. Pharmacological Management 6:

   • Corticosteroids for patients requiring oxygen
   • Consideration of baricitinib or tofacitinib in combination with glucocorticoids
   • Anticoagulation strategies based on disease severity

Practical Considerations

Safety Concerns

• HBOT facilities could potentially increase viral transmission risk due to:
  • Confined chamber spaces
  • Challenges in maintaining infection control protocols 7
  • Difficulty implementing aerosol precautions in hyperbaric environments

Resource Allocation

• HBOT requires:
  • Specialized equipment and facilities
  • Trained personnel
  • Significant resources that may be better allocated to established treatments

Clinical Decision Making

For patients with viral infections including COVID-19:

1. First-line approaches:

   • Follow established guidelines for respiratory support 6, 1
   • Implement evidence-based pharmacological interventions 6
   • Consider prone positioning for hypoxemic patients 6, 1

2. Consider HBOT only in specific circumstances:

   • As part of approved clinical trials
   • When conventional therapies have failed
   • In facilities with experience managing infectious patients in hyperbaric environments
   • For patients with specific indications where HBOT has established benefits (e.g., certain wound healing applications) who also have viral infections

Future Directions

While current evidence does not support routine use of HBOT for viral infections, ongoing research may clarify:

• Optimal patient selection criteria
• Timing of intervention
• Treatment protocols
• Specific viral conditions that might benefit from HBOT

Conclusion

Until robust evidence from large randomized controlled trials becomes available, clinicians should adhere to established guidelines for managing viral infections including COVID-19, which currently do not include HBOT as a recommended intervention 6, 1.