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Hyperbaric Oxygen Therapy for Post-COVID-19 Syndrome (HBOTpCOVID)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT04647656
Recruitment Status : Completed
First Posted : December 1, 2020
Last Update Posted : January 27, 2022
Information provided by (Responsible Party):
Assaf-Harofeh Medical Center

Brief Summary:
Post-COVID-19 syndrome is an assembly of symptoms, following an infection with Coronavirus disease 2019 (COVID-19). The syndrome is characterized by cognitive impairment, fatigue, sleep disorders, smell and taste disorders, pain and more. This long-term sequela can last for months after recovering from the virus, and no treatment is known to date. The aim of this study is to compare the effect of HBOT vs. Sham on post COVID-19 syndrome

Condition or disease Intervention/treatment Phase
Covid19 Neurocognitive Dysfunction Device: Hyperbaric oxygen Device: Sham Not Applicable

Detailed Description:

Post-COVID-19 syndrome is an assembly of signs and symptoms first described on patients recovering from severe Coronavirus 2019 (COVID-19) infection. The syndrome is characterized by cognitive impairment, fatigue, and other neurologic symptoms. With time, and the growing understanding on this unique virus, there is cumulative case series reports on patients with mild to moderate disease, suffering from long standing post-COVID-19 syndrome. Taking in consideration, this pandemic is worldwide and still spreading, there's an urgent need for effective treatment for those patients who are suffering from the long standing, life debilitating, post-COVID-19 syndrome.

Neurologic signs and symptoms are common during hospitalization with COVID-19, with 42% of patients at onset of the disease and 82% during the course of the disease. Patients report mainly on myalgias, headaches, encephalopathy, dizziness, dysgeusia, and anosmia. After recovering from COVID-19, many patients continue to suffer from symptoms. Only 13% of the patients were completely free of symptoms after full resolution of the virus. The main symptom, reported by more than half the patients included cognitive impairment, fatigue and sleep disorders. A recent study analyzed data from 84,285 Individuals who recovered from suspected or confirmed COVID-19 showed reduced cognitive performance. This deficit scales with symptom severity and is evident amongst those without hospital treatment.

Two main biological sequelae of COVID-19 might play a role in the pathogenesis of this syndrome. The first is hypercoagulability state accompanies acute infection. This is characterized by increased risk of small and large vessel occlusion and is associated with increased mortality [9]. Neurologic complications might be a result of micro-infarcts in the central of peripheral nervous system; The second is an uncontrolled inflammatory response, called cytokines storm. This cytokine release is characterized by an increase in interleukin (IL)-1, IL-6, tumor necrosis factor (TNF)-α and a change in macrophages population. Thus, COVID-19 can cause neuroinflammation, that might be prolonged and lead to signs of post-COVID-19 syndrome.

The Micro-infarcts and neuroinflammation are important causes of local hypoxia, and specifically neurological hypoxia. One of the options to reverse hypoxia, reduce neuroinflammation and induce neuroplasticity is hyperbaric oxygen therapy (HBOT).

Hyperbaric oxygen therapy (HBOT) includes the inhalation of 100% oxygen at pressures exceeding 1 atmosphere absolute, thus enhancing the amount of oxygen dissolved in the body tissues. During HBOT, the arterial O2 tension typically exceeds 2000 mmHg, and levels of 200-400 mmHg occur in tissues Even though many of the beneficial effects of HBOT can be explained by improvement of tissue oxygenation, it is now understood that the combined action of hyperoxia and hyperbaric pressure, triggers both oxygen and pressure sensitive genes, resulting in inducing regenerative processes including stem cells proliferation and mobilization with anti-apoptotic and anti-inflammatory factors.

The HBOT protocol will be administrated in a multi-place chamber. The protocol includes 40 daily sessions, 5 sessions per week for two months. Treatment group will subjected to 100% oxygen by mask at 2 atmosphere (ATA) for 90 minutes with 5 minute air breaks every 20 minutes. Sham group will be subjected to 21% oxygen by mast for 90 minutes, at 1.2 ATA during the first five minutes of the session with the noise of circulating air, and then decrease slowly during the next five minutes to 1.03 ATA.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 91 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Hyperbaric Oxygen Therapy for Post-COVID-19 Syndrome: a Prospective, Randomized, Double Blind Study.
Actual Study Start Date : December 14, 2020
Actual Primary Completion Date : December 27, 2021
Actual Study Completion Date : January 10, 2022

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: HBOT treatment group
40 daily hyperbaric oxygen treatment sessions will be administered 5 days per week
Device: Hyperbaric oxygen
Each session will include exposure of 90 minutes to 100% at 2 ATA, with 5 minutes air breaks every 20 minutes

Sham Comparator: HBOT sham group
40 daily Sham non-hyperbaric oxygen treatment will be administered 5 days per week
Device: Sham
Each session will include exposure of 90 minutes to 21% at 1.2 ATA during the first five minutes of the session with the noise of circulating air, and then decrease slowly during the next five minutes to 1.03 ATA

Primary Outcome Measures :
  1. Cognitive health assessment (NeuroTrax) [ Time Frame: Baseline, 2 months ]
    Memory, attention and information process will be evaluated using the NeuroTrax computerized cognitive evaluation battery.

Secondary Outcome Measures :
  1. Brain perfusion [ Time Frame: Baseline, 2 months ]
    Cerebral blood volume and flow will be measured using perfusion MRI protocol Dynamic susceptibility contrast (DSC).

  2. Brain microstructure Brain microstructure [ Time Frame: Baseline, 2 months ]
    Fractional anisotropy (FA) and Mean diffusivity (MD) will be evaluated using diffusion tensor imaging (DTI) MRI protocol

  3. Brain function imaging [ Time Frame: Baseline, 2 months ]
    Resting state fMRI (rsfMRI), and task based fmri will evaluate brain function during a working memory task

  4. Post-COVID-19 symptom [ Time Frame: Baseline, 2 months ]
    Self-reported questionnaire covers the most common symptoms related to post-coronavirus 2019 (COVID-19) disease

  5. Quality of Life SF-36 [ Time Frame: Baseline, 2 months ]
    Short Form (SF)-36 questionnaire for self reporting quality of life

  6. The Pittsburgh Sleep Quality Index PSQI [ Time Frame: Baseline, 2 months ]
    The Pittsburgh Sleep Quality Index (PSQI) is a self-report questionnaire that assesses sleep quality

  7. The Brief Symptom Inventory - 18 (BSI-18) [ Time Frame: Baseline, 2 months ]
    The BSI-18 will be used to evaluate psychological distress. The BSI-18 is an 18 item self-report questionnaire which generates a summary scale, the global stress index (GSI), and three subscales: depression, anxiety, and somatization

  8. BPI - Brief pain inventory (short form) [ Time Frame: Baseline, 2 months ]
    The Brief pain inventory (BPI) is a short, self-administered questionnaire. It contains 15 items, which include 2 multi-item scales measuring pain intensity and the impact of pain on functioning and well-being.

  9. Neuro-physical evaluation [ Time Frame: Baseline, 2 months ]

    Static balance will be assessed by the Balance Error Scoring System (BESS); Dynamic balance and risk of falling will be assessed by the Timed Up and Go test (TUG) and 10-meter walk (10MW).

    Muscle function will be assessed by the sit to stand (STS) test for the leg strength and endurance and hand-held dynamometry (HHD) for the isometric grip strength.

    The sub-maximal aerobic capacity and endurance will be assessed by the 6-minute walk test (6MWT).

  10. Neurological evaluation [ Time Frame: Baseline, 2 months ]
    The neurological exam will include tests of the cranial nerves, motor, sensory and cerebellar function and gait

  11. Smell and taste evaluations. [ Time Frame: Baseline, 2 months ]

    Smell will be tested through smell identification kits to test for odour detection, discrimination and threshold. The kit is standardized for age and gender, and available in different languages (Sniffing sticks).

    Taste will be tested on bilateral anterior and posterior parts of the tongue by four tastes: bitter, sour, salt and sweet ("The Taste Strip Test").

  12. Cardiopulmonary exercise test [ Time Frame: Baseline, 2 months ]
    The cardiopulmonary exercise test (CPET) is a non-invasive measurement of the cardiovascular system, respiratory system and muscles.

  13. Echocardiography [ Time Frame: Baseline, 2 months ]
    Conventional echocardiography evaluation, linear, volumetric and Doppler measurements will be performed to assess cardiac functions.

  14. Lung functions test [ Time Frame: Baseline, 2 months ]
    Measurements of pulmonary functions will be performed using spirometry (the MiniSpir) testing apparatus.

  15. Immune system [ Time Frame: Baseline, 2 months ]
    Blood tests will evaluate immune system including cytokines, c-reactive protein (CRP) and COVID-19 antibodies

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Age above 18 years
  2. Reported post COVID-19 cognitive deterioration that effect quality of life and persist at least 3 months after confirmed infection.
  3. Subject willing and able to read, understand and sign an informed consent

Exclusion Criteria:

  1. Inability to attend scheduled clinic visits and/or comply with the study protocol
  2. History of traumatic brain injury (TBI) or any other non COVID brain pathology
  3. Active malignancy
  4. Substance use at baseline
  5. Severe or unstable physical disorders or major cognitive deficits at baseline
  6. HBOT for any reason prior to study enrolment
  7. Chest pathology incompatible with pressure changes (including moderate to severe asthma)
  8. Ear or Sinus pathology incompatible with pressure changes
  9. An inability to perform an awake brain MRI
  10. Active smoking

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT04647656

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Assaf-Harofeh medical center
Zerifin, Israel, 70300
Sponsors and Collaborators
Assaf-Harofeh Medical Center
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Responsible Party: Assaf-Harofeh Medical Center Identifier: NCT04647656    
Other Study ID Numbers: 332-20-ASF
First Posted: December 1, 2020    Key Record Dates
Last Update Posted: January 27, 2022
Last Verified: January 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Cognitive Dysfunction
Respiratory Tract Infections
Pneumonia, Viral
Virus Diseases
Coronavirus Infections
Coronaviridae Infections
Nidovirales Infections
RNA Virus Infections
Lung Diseases
Respiratory Tract Diseases
Cognition Disorders
Neurocognitive Disorders
Mental Disorders