Submitted by: Sujith Vasanthakumar, SRT, Conestoga College

Amidst the COVID-19 pandemic, researchers across the globe raced against the clock to develop viable therapies that could reduce the symptomatology of the disease. The most vulnerable populations to the virus, which include the sick and elderly, face a poor prognosis; increased susceptibility to the disease has been correlated with the rapid onset of dyspnea and hypoxemia, which is often followed by the development of acute respiratory distress syndrome (ARDS) (Wu, Chen & Cai, 2020). Severe dyspnea and hypoxemia in patients with COVID-19 has been correlated with the presence of pulmonary lesions and inflammation within the lower respiratory tract (Nie, Han, Huangqing & Zhang, 2020). Inflammation within the bronchioles is caused by a heightened immune response to the COVID-19 viral infection, resulting in a rapid accumulation of cytokines within respiratory tissues. This “cytokine storm” phenomenon is responsible for the symptomology of dyspnea and subsequent progression towards the more fatal ARDS by compromising the alveoli (Tang, Liu, Zhang, Ji & Wen, 2020). Numerous therapies are being tested to treat the symptoms that arise from the cytokine storm, however several of these therapies are accompanied by severe side effects that can exacerbate existing symptoms.

The clinical application of medical gases for the purposes of treating symptoms of inflammation and dyspnea are long standing staples in respiratory therapy. Oxygen therapy has been shown to be an effective treatment for mitigating pulmonary inflammation in patients with COVID-19 without the risk of having harsh side effects (Horowitz, Freeman & Bruzzese, 2020). A recent study on rats by Cui and colleagues (2016) showed that hydrogen as a therapeutic gas could mitigate the activation of proinflammatory cytokines. A novel therapeutic study was conducted to determine if utilizing hydrogen/oxygen hybrid gas would be a more viable therapy for mitigating the symptomology of COVID-19 related cytokine storm, over oxygen therapy (Guan et al., 2020). The researchers aimed to determine if hydrogen could effectively prevent dyspnea by improving airway resistance in patients with COVID-19. A total sample size of 90 patients with symptoms of dyspnea were utilized in this study, aged between eighteen to eighty-five. The treatment cohort was treated with inhalation of [66:33] hydrogen: oxygen mixture, while the control cohort was treated with standard oxygen therapy (Guan et al., 2020); treatments were applied until the date of discharge. The researchers wanted to determine if treatment with the hybrid gas was significantly more beneficial than oxygen therapy alone, by monitoring the severity of dyspnea, hypoxemia, cough, chest distress and chest pain. The findings of the study showed that patients who received the hydrogen: oxygen mix experienced a significantly reduced severity in symptomology compared to patients who received traditional oxygen therapy (Guan et al., 2020). The researchers found that the reduction in severity of the disease also occurred at a far greater rate utilizing the hydrogen: oxygen therapy than standard oxygen therapy, with a higher proportion of patients showing signs of recovery within three days.

The administration of hydrogen/oxygen mixed gas as a viable treatment for symptoms arising from COVID-19 appears very promising. Guan and colleagues (2020) established that symptoms of dyspnea and hypoxemia can be alleviated by reducing airway resistance, which is directly associated with heightened levels of pulmonary inflammation. Hydrogen as a therapeutic gas utilizes a two-pronged course of action: the lower density of the gas facilitates a more efficient flow of oxygen to the alveoli for increased saturation, and the hydrogen itself acts upon the proinflammatory cytokines to reduce inflammation. As a therapeutic, a blend of hydrogen and oxygen medical gases appears to be one of the few therapies that can alleviate symptoms in COVID-19 patients without the risk of introducing side effects. The therapy is also incredibly cost-efficient compared to the other treatments, as hydrogen is readily available via electrolysis of water (Cui et al., 2016); the relative cost efficiency suggests that hydrogen/oxygen therapy could be more readily available to the public throughout the pandemic, whereas other modes of treatment are hindered by shortages. In addition, regions in the world that lack resources or funding are limited in offering effective treatments for COVID-19 and could benefit from having a more cost-efficient alternative for treatment.

Within the field of respiratory therapy, the application of hydrogen/oxygen mixed medical gases is a milestone during this pandemic; however, further studies need to be conducted to verify treatment efficacy. Guan et al. (2020) were limited to a small sample size and lack of randomization due to the urgency of finding a viable treatment; therefore, additional clinical studies would need to be conducted to support their findings.

References

Cui, J., Chen, X., Zhai, X., Shi, D., Zhang, R., Zhi, X., Li, X., Gu, Z., Cao, L., Weng, W., Zhang, J., Wang, L., Sun, X., Ji, F., Hou, J., & Su, J. (2016)
Inhalation of water electrolysis-derived hydrogen ameliorates cerebral ischemia-reperfusion injury in rats – A possible new hydrogen resource for clinical use. Neuroscience, 232-241.
https://www-sciencedirect-com.eztest.ocls.ca/science/article/pii/S0306452216303943#!

Guan, W., Wei, C., Chen, A., Sun, Guo, G., Zou, X., Shi, J., Lai, P., Zheng, Z., & Zhong, N. (2020).
Hydrogen/oxygen mixed gas inhalation improves disease severity and dyspnea in patients with Coronavirus disease 2019 in a recent multicenter, open-label clinical trial. Journal of Thoracic Disease.
http://jtd.amegroups.com/article/view/40994/html

Horowitz, R., Freeman, P., & Bruzzese, J. (2020).
Efficacy of glutathione therapy in relieving dyspnea associated with COVID-19 pneumonia: A report of 2 cases. Respiratory Medicine Case Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172740/

Nie, S., Han, S., Huangqing, O., & Zhang, Z. (2020).
Coronavirus Disease 2019-related dyspnea cases difficult to interpret using chest computed tomography. Respiratory Medicine.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195086/

Tang, Y., Liu, J., Zhang, D., Ji, J., & Wen C. (2020).
Cytokine Storm in COVID-19: The Current Evidence and Treatment Strategies. Frontiers in Immunology, 11, 1708.
https://doi.org/10.3389/fimmu.2020.01708

Wu, C., Chen, X., & Cai, Y. (2020).
Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan China. JAMA Internal Medicine, 180 (7), 934-943.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/276318

[printfriendly]