Can Hyperbaric Oxygen Therapy Help Long COVID Symptoms?
Yes, with caveats. This systematic review of 10 studies found that HBOT can improve quality of life, fatigue, cognition, neuropsychiatric symptoms, and heart/lung function in long COVID patients. However, more rigorous trials are needed before making definitive recommendations.
Long COVID affects an estimated 20-50% of people after COVID-19 infection. Symptoms like fatigue, brain fog, and shortness of breath can last for weeks or months. Hyperbaric oxygen therapy (HBOT) has shown promise as a treatment, but how strong is the evidence?
What the Research Shows
The review found 10 studies on HBOT for long COVID:
- 1 case report
- 5 one-group studies (before-and-after design, no control group)
- 1 safety report from a randomized controlled trial
- 3 complete randomized controlled trials (all from the same patient population)
Key findings across studies:
- Quality of life: Significant improvements reported
- Fatigue: Reduced symptoms, sometimes after just 15 sessions
- Cognition: Improved memory, attention, executive function
- Brain imaging: Enhanced brain perfusion and microstructure on MRI
- Heart function: Improved left ventricular function
- Anxiety and depression: Reduced symptoms
Dr. Kumar’s Take
This review is encouraging but comes with important context. The evidence is mostly from small studies or studies without proper control groups. The three randomized trials all came from the same institution and patient population, which limits how much we can generalize. That said, the consistency of improvement across different outcomes (cognitive, cardiac, psychological) suggests HBOT may address multiple aspects of long COVID pathology. I’m cautiously optimistic but waiting for larger, well-designed trials.
How HBOT Might Help Long COVID
The proposed mechanisms include:
Reduced inflammation: HBOT may lower oxidative stress and inflammatory markers. One study showed decreased reactive oxygen species, lipid damage, and inflammation biomarkers after treatment.
Improved brain function: HBOT may trigger neuroplasticity (the brain’s ability to rewire itself), leading to cognitive improvements visible on brain imaging.
Enhanced oxygen delivery: Higher oxygen levels may help tissues damaged by COVID-19 heal more effectively.
Mitochondrial support: HBOT may improve how cells produce energy, which could explain benefits for fatigue and muscle function.
What the Randomized Trials Found
The most rigorous evidence comes from three RCTs (all from the same population):
Cognitive outcomes: Significant improvements in global cognitive function, attention, and executive function. Brain MRI showed improved perfusion and microstructure.
Brain connectivity: Enhanced connectivity in networks related to cognitive control and emotional recovery.
Heart function: Improved left ventricular function, with 62.5% of HBOT patients achieving normal levels vs 38.4% in the sham group.
Important Limitations
The review authors highlight several concerns:
- Most studies lacked control groups
- The three RCTs used the same patient population
- Diagnostic criteria and timing for “long COVID” varied
- HBOT protocols (pressure, frequency, duration) differed between studies
- Assessment tools were inconsistent
- Adverse effects included cough and chest discomfort in about 60% of one study’s participants
Practical Takeaways
- HBOT shows promise for long COVID but evidence is still limited
- Benefits may include improved cognition, reduced fatigue, and better heart function
- Treatment typically involves 10-60 sessions in a pressurized chamber
- Side effects like cough and chest discomfort are possible
- More research is needed before HBOT can be widely recommended
Related Studies and Research
- Ardenne Institute Official: Oxygen Multistep Therapy
- EWOT for exercise-induced low blood oxygen (88% improved)
- Athletic performance study
- Long-Term Oxygen Treatment Trial (LOTT)
FAQs
How many HBOT sessions are needed for long COVID?
Studies used anywhere from 10 to 60 sessions. In one case report, improvements in fatigue were seen after 15 sessions, with full recovery after 60 sessions.
Is HBOT covered by insurance for long COVID?
Currently, long COVID is not an approved indication for HBOT by most insurers. Check with your insurance provider and HBOT center about coverage options.
Are there risks with HBOT for long COVID?
Adverse effects reported include cough and chest discomfort, occurring in about 60% of patients in one safety analysis. No serious adverse events were documented.
How does HBOT compare to other long COVID treatments?
No direct comparisons exist. HBOT is one of several treatments being studied, including rehabilitation programs, medications, and other therapies.
Bottom Line
This systematic review finds that hyperbaric oxygen therapy shows promise for treating long COVID symptoms, including fatigue, cognitive impairment, and reduced quality of life. Multiple studies report improvements, and randomized controlled trials show benefits for brain function and heart health. However, the evidence base is limited by small sample sizes, lack of control groups in most studies, and reliance on a single institution for the RCT data. Larger, well-designed trials are needed to establish precise treatment protocols and confirm which patients benefit most.
