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Oxigenoterapia hiperbárica aplicada ao tratamento de COVID longo
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A COVID-19 é uma doença infecciosa desencadeada pelo vírus SARS-CoV-2, que resultou numa pandemia marcada por taxas de morbimortalidade sem precedentes, contribuindo para uma crise de saúde pública global. Cedo tornou-se evidente a emergência de uma nova síndrome, denominada de COVID Longo, definida pela persistência de sintomas ou o desenvolvimento de sequelas, no mínimo, quatro semanas após o diagnóstico de COVID-19. Com prevalência estimada em cerca de 10-30%, podendo alcançar 87% em doentes previamente hospitalizados, o COVID Longo apresenta um vasto espectro clínico e pode afetar múltiplos sistemas orgânicos. Os sintomas mais comuns incluem fraqueza muscular, mal-estar geral, fadiga, défice de concentração, dispneia e declínio da qualidade de vida. O seu diagnóstico implica a exclusão de causas alternativas para a sintomatologia manifestada e de complicações graves, e requer uma abordagem holística por parte dos profissionais de saúde, através de equipas multidisciplinares, conciliando o tratamento sintomático, com a reabilitação funcional e social. As opções terapêuticas atualmente disponíveis para esta condição são limitadas, existindo uma necessidade crescente de tratamentos eficazes. Dada a sua aplicabilidade em doenças com quadros clínicos semelhantes ao COVID Longo, e atendendo aos mecanismos fisiopatológicos subjacentes a esta entidade, a oxigenoterapia hiperbárica (OTHB) tem sido objeto de investigação na reversão dos sintomas mais prevalentes. Estudos iniciais revelam eficácia na correção da fadiga, dispneia de esforço, declínio físico e cognitivo (brain fog), e perturbações psiquiátricas. A investigação futura deve centrar-se no reconhecimento do grupo de doentes com maior benefício em OTHB, na padronização do esquema terapêutico adequado e no seguimento mais prolongado dos doentes submetidos a esta terapêutica.
COVID-19 is an infectious disease caused by the SARS-CoV-2 virus, which resulted in a pandemic with unprecedented high morbimortality and therefore a global public health crisis. Soon became clear the emergence of a new syndrome referred as Long COVID, defined by signs and symptoms that develop during or after an infection consistent with COVID‑19 and continue for more than four weeks after acute disease. Having an estimated prevalence of 10-30%, which can be up to 87% in previously hospitalized patients, Long COVID manifests with a wide clinical spectrum and may affect multiple organ systems. The most common symptoms include muscle weakness, general malaise, fatigue, concentration problems, dyspnea and quality-of-life impairment. The diagnosis involves the exclusion of alternative causes for the symptoms presented as well as severe complications, requiring a holistic approach by all healthcare workers throughout multidisciplinary teams, and balancing symptomatic treatment with both functional and social rehabilitation. Currently available therapeutic options for this clinical condition are limited, as the need for finding effective treatments increases. Bearing in mind its current application in other medical conditions with a clinical presentation similar to Long COVID, and because of the pathophysiology mechanisms underlying this disorder, hyperbaric oxygen therapy (HBOT) has been subject for investigation by the scientific community, as a potential treatment capable of reverting some of the most prevalent symptoms. Initial studies revealed HBOT’s beneficial effects on improving fatigue, exertional dyspnea, physical and cognitive decline (brain fog) and psychiatric disorders. Future investigation should focus on the selection of patients who would most likely benefit from HBOT, standardizing therapeutic strategies and on longer post-trial follow-up periods.
COVID-19 is an infectious disease caused by the SARS-CoV-2 virus, which resulted in a pandemic with unprecedented high morbimortality and therefore a global public health crisis. Soon became clear the emergence of a new syndrome referred as Long COVID, defined by signs and symptoms that develop during or after an infection consistent with COVID‑19 and continue for more than four weeks after acute disease. Having an estimated prevalence of 10-30%, which can be up to 87% in previously hospitalized patients, Long COVID manifests with a wide clinical spectrum and may affect multiple organ systems. The most common symptoms include muscle weakness, general malaise, fatigue, concentration problems, dyspnea and quality-of-life impairment. The diagnosis involves the exclusion of alternative causes for the symptoms presented as well as severe complications, requiring a holistic approach by all healthcare workers throughout multidisciplinary teams, and balancing symptomatic treatment with both functional and social rehabilitation. Currently available therapeutic options for this clinical condition are limited, as the need for finding effective treatments increases. Bearing in mind its current application in other medical conditions with a clinical presentation similar to Long COVID, and because of the pathophysiology mechanisms underlying this disorder, hyperbaric oxygen therapy (HBOT) has been subject for investigation by the scientific community, as a potential treatment capable of reverting some of the most prevalent symptoms. Initial studies revealed HBOT’s beneficial effects on improving fatigue, exertional dyspnea, physical and cognitive decline (brain fog) and psychiatric disorders. Future investigation should focus on the selection of patients who would most likely benefit from HBOT, standardizing therapeutic strategies and on longer post-trial follow-up periods.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
COVID-19 COVID longo Condição pós-COVID-19 Oxigenoterapia hiperbárica Doenças transmissíveis