Evidence Review for HBO2 Treatment of Covid-19 Webinar

Table of Contents:

• Session 1: Pathophysiology of COVID-19
• Session 2: Clinical course of COVID-19 and the possible role of HBO 2
• Session 3: Safety concerns for the use of HBO 2 in COVID-19 patients
• Session 4: Operational considerations for the use of HBO 2 in COVID-19 patient
• Session 5: Translation of research into practice
• Session 6: Abstract presentations
• Session 7: Synthesis of the Data

Objectives:

• Give an overview of the SARS-CoV-2 virus, its transmission, and how it acts on the body.
• Describe the clinical course of COVID-19 from asymptomatic patients through ventilated patients, identifying any opportunities for intervention using HBO2. This session will also summarize the published clinical experience treating COVID-19 patients with HBO2.
• Discuss the potential hazards to COVID-19 patients that need to be addressed and studied including pulmonary oxygen toxicity and sick patients leaving ICU to go to HBO2 department.
• Discuss operational considerations for facilities who intend to treat COVID-19 patients including, infection control in the hyperbaric chamber and staff education.
• Discuss the balance between compassionate uses of HBO2 versus the need for IRB-approved, evidence-based research including strategies to translate limited evidence into clinical practice.
• Attempt to synthesize the data that has been presented into a cohesive document with three general goals:
  • What questions have we answered?
  • What questions still need to be answered?
  • What elements of study design should be incorporated in future studies?

Price:

• Non-Member: $123.75
• Regular UHMS Member: $96.25
• Associate UHMS Member: $68.75

Estimated time to complete this activity: 5.50 hours

Accreditation Statement: The Undersea and Hyperbaric Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physician.

Disclosure: All faculty members and planners participating in continuing medical education activities sponsored by UHMS are expected to disclose to the participants any relevant financial relationships with commercial interests. Full disclosure of faculty and planner relevant financial relationships will be made at the activity.

Designation Statements (CME/CEU Approvals):

Physician CME: The Undersea & Hyperbaric Medical Society designates this enduring material for a maximum of 5.50 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

MOC ABPM: This activity has been approved by the American Board of Preventive Medicine for up to 5.50 MOC credits. Claiming ABPM MOC credit is appropriate for those who are ABPM diplomates.

Nursing/RRT: This enduring material is approved for 5.50 contact hours provided by Florida Board of Registered Nursing/RRT Provider #50-10881.

For NBDHMT: This enduring material is approved for 1.00 Category A and 4.50 Category B credit hours by National Board of Diving and Hyperbaric Medical Technology, 9 Medical Park, Suite 440, Columbia, South Carolina 29203

Termination Date: August 18, 2023

Disclaimer: The information provided by this CME material is for Continuing Medical Education purposes only. The lecture content, statements or opinions expressed however, do not necessarily represent those of the Undersea and Hyperbaric Medical Society (UHMS), its affiliates or its employees.

Goal: For over 40 years the UHMS has been the primary source of information for hyperbaric medicine and physiology worldwide. This enduring material has as its goal to address identified professional practice gaps and provide a quality CME opportunity which will improve scientific knowledge and skills for hyperbaric and wound care: physicians, nurses and technicians, and other clinicians and personnel whose practice includes hyperbaric medicine and wound care.

Target Audience – physicians, nurses, CHT’s or anyone with an interest in the COVID-19 pandemic and use of hyperbaric oxygen therapy.

All individuals in control of content for this educational activity with their relevant financial relationship disclosed are listed below. ACCME defines a relevant financial relationship “as financial relationships in any amount occurring within the past 12 months that create a conflict of interest.” An individual who refuses to disclose relevant financial relationships will be disqualified from being a planning committee member, a teacher, or an author of CME, and cannot have control of, or responsibility for, the development, management, presentation or evaluation of the CME activity.

About the presenters

Nick Bird, MD

Dr. Nicholas Bird is a regional medical director for Duke Urgent Care and is board-certified in both family medicine and undersea and hyperbaric medicine. He splits his time between clinical practice and administrative responsibilities, and has a passion for improving health care delivery to optimize patient access, education and outcomes. Prior to joining the Duke medical staff, he was the chief medical officer and CEO of Divers Alert Network and an internationally recognized expert on diving injuries, accidents and medical treatment. Outside of work, he enjoy traveling, and diving the warm waters of the world. He has been a PADI SCUBA instructor for more than 25 years. He also enjoys reading Clive Cussler novels, cooking and golfing, when time permits. He lives in Durham, NC with his wife, Kim. They have three children, a grandson, and a crazy Jack Russell terrier.

Kialing Perez, MD

Dr. Kialing Perez is currently an ID specialist for Peachealth since 2009. He is also a hyperbaric physician in a monoplace environment and Board Certified in Infectious Diseases, American Board of Internal Medicine and is also a Diving Medical Examiner.

Objectives:

1. The participant will learn current epidemiology for the COVID-19 outbreak.
2. The participant will learn current testing technology.
3. The participant will get an update on vaccines and treatments

Sandra Wainwright, MD

Dr. Wainwright earned her medical degree from St. George’s University School of Medicine in Grenada, West Indies. In 2000, Dr. Wainwright began her internship and residency training at Norwalk Hospital – a Yale University School of Medicine affiliate. She was asked to stay on as Chief Resident and was awarded the Samuel Floch award – presented by resident peers to the individual who most exemplified excellence and collegiality among colleagues.

Dr. Wainwright was accepted for the combined Pulmonary and Critical Care Fellowship at Norwalk and Yale in 2004. She completed her training in 2007 and is boarded in Internal Medicine, Pulmonary and Critical Care. She declined a teaching position at Yale, when she was offered the opportunity to become the Medical Director of the Norwalk Hospital Wound Care and Hyperbaric Center in 2007.

Under her leadership, the Norwalk Hospital Hyperbaric facility was awarded a generous donation to purchase and become the first department in the hospital to acquire an electronic medical record. Although the center was the first Hyperbaric center in the Northeast, established in 1976, Dr. Wainwright successfully led the center to its accreditation with the UHMS in 2013.

Dr. Wainwright has been working at Norwalk Hospital since 2007 and is fully clinical in the fields of Wound Care and Hyperbaric medicine as well as Pulmonary and Critical Care. She is currently a Faculty member for both the Pulmonary fellowship and Internal Medicine residency programs as well as an associate professor at the Norwalk Respiratory Therapy School and New York Medical College, School of Medicine. She has published an eclectic selection of topics including a chapter in Braunwald’s Primary Cardiology textbook on Heart disease in the Pregnant Woman. As a Fellow her abstract on Use of Exhaled Nitric Oxide in Assessment of Adherence in an Inner City Asthma Clinic was accepted for presentation at the American Thoracic Society in 2006. She presented an abstract to the SAWC in 2009 on a case series of patients with calcific uremic arteriolopathy and the role of hyperbaric medicine in wound healing and mortality rates. She has co-authored a paper that was just accepted for publication in the Journal of the American Podiatric Medical Association on healing venous disease with advanced surgical and wound healing modalities. Dr Wainwright has also participated in the peer evaluation process for authors seeking submission to the Undersea and Hyperbaric Medicine Journal.

Dr. Wainwright has recently engaged in regional and national continuing medical education and scientific meetings and has lectured in a variety of topics including calciphylaxis, venous disease, necrotizing fasciitis, carbon monoxide evaluation, management and literature review, the human microbiome, limb salvage and an introductory course in hyperbaric medicine.

Scott Gorenstein, MD

Dr. Scott Gorenstein is a board certified Emergency Medicine Physician and board certified in Undersea and Hyperbaric Medicine. Dr. Gorenstein has been involved with clinical research in wound care and regenerative medicine at NYU Winthrop. During the height of the pandemic in NYC Dr. Gorenstein and his team treated over 20 patients in an IRB approved case controlled study looking at hyperbaric oxygen for COVID 19. He is a past president of the NE chapter of the UHMS and serves as a peer reviewer for several journals.

Objectives:

1. Understand how unstable the COVID 19 patient is.
2. Learn about best practices for safely treating COVID 19 patients with HBO2.

Marcus S. Speyrer, RN, CWS, DAPWCA

Marcus S. Speyrer, RN, CWS, DAPWCA is the Chief Operating Officer and Partner in The Wound Treatment Center, LLC & The Wound Treatment Center Consulting, LLC @ Opelousas General Health System in Opelousas, LA. He began in wound care in 1993. He is a Registered Nurse and Certified Wound Specialist. He received his Associate Degree in Nursing at the University of New York Regents College in 1995. He has participated in numerous research trials and has several publications. He is a member of the Editorial Advisory Board for the peer-reviewed journal, WOUNDS. He has served on numerous advisory panels and is a consultant with 3M™/KCI and Organogenesis Speakers’ Bureau. Member of Undersea Hyperbaric Medical Society, Association for the Advancement of Wound Care and American Professional Wound Care Association.

Objectives:

1. Review process for HBO2T & Covid-19.
2. Review transporting process for Covid-19 patients.
3. Review disinfecting process

Michael Bennett, MD, PhD

Professor Michael Bennett is a DHM physician and anaesthetist at Prince of Wales Hospital and the Prince of Wales Clinical School in Sydney, Australia and has been a member of the UHMS since 1993. He has a specific interest in clinical epidemiology, research methodology and Evidence-based Medicine. He is an experienced clinician and researcher, and the author of a chapter concerning randomized controlled trials in the UHMS Indications book. Michael is a staunch advocate of evidence-based practice in hyperbaric medicine.

Objectives:

1. Outline the purposes of peer review, open publication and IRB approval in the context of bridging research and practice. 
2. Discuss the ethics of using 'off label' therapies.
3. Outline a rational balance between expediency and protocol in a health crisis.

John Feldmeier, DO

Dr. John Feldmeier is a 1970 graduate of Duquesne University in Pittsburgh, Dr. Feldmeier initially served as a meteorologist in the USAF Weather Service until 1975. He received his D.O. degree from The Philadelphia College of Osteopathic Medicine in 1979 with USAF sponsorship and completed residency training in Radiation Oncology at the University of Texas Health Science Center at San Antonio, Texas. He received a fellowship certificate from the USAF Hyperbaric Medicine Fellowship Training Program at Brooks Air Force Base in San Antonio, Texas and was a staff physician there from 1980 to 1982. Dr. Feldmeier then served as the Chief of Radiation Oncology from 1985 to 1987 and ultimately simultaneous Chairman of the Hyperbaric Medicine Department at Wright-Patterson Air Force Base Medical Center in Dayton, Ohio. He returned to the University of Texas Health Science Center as faculty in 1987 and ultimately became Chief of Radiation Oncology there. He was also the Radiation Oncology Residency Program Director there before leaving to join the faculty at Wayne State University. He became Division Chief and Clinical Chief of Radiation Oncology at Grace Hospital in Detroit, Michigan in 1993. In 1997 he joined the University of Toledo and served as Department Chairman of Radiation Oncology there until his retirement from that position in 2013. He was named Professor Emeritus upon his retirement.

Dr. Feldmeier has authored numerous publications in both radiation oncology and hyperbaric medicine. He has been the editor of the Undersea & Hyperbaric Medical Society (UHMS) Hyperbaric Oxygen Therapy Committee Report which provided the rationale for the UHMS Accepted Indications for HBO2. He served a review editor of the UHMS scientific journal, Undersea and Hyperbaric Medicine. He is a Fellow of Undersea and Hyperbaric Medicine and continues on the UHMS Board of Directors as Past-President of the UHMS. He is a Fellow of the American College of Radiation Oncology. He has been recognized as one of “The Best Doctors in America” since 2007 until his retirement. He was honored to be selected to deliver one of two keynote addresses for the 2017 UHMS 50th Anniversary Meeting.

Objectives:

• The attendee will be able to state concerns related to applying HBO2 to the treatment of COVID-19 patients.
• The attendee will be able to state potential benefits of HBO2 to the COVID-19 patient.

Pasquale Longobardi, MD

Dr. Pasquale Longobardi, MD
Address: Centro iperbarico, via Augusto Torre, 3 - 48124 Ravenna (RA),
Ph: +39-0544-500152. work e-mail: direzione@iperbaricoravenna.it; web site: www.iperbaricoravenna.it

“Tridente d’oro 2009” awarded for the high degree of professionalism achieved in the sensitive field of hyperbaric and under water medicine with prestigious International appointments, lectures and consultancies in Italy and abroad, worldwide relevant publications, and expert in diving. With his unrelenting work, he honours at the highest levels the remarkable Italian tradition of hyperbarism.

• 1986 Degree in Medicine and Surgery, Naples University (I).
• 1989 Postgraduate specialisation in Diving and Hyperbaric Medicine, Chieti University (I).
• 1997 Two- year master course in Health Management and Organisation at the Management school “L. Bocconi”, Milan (I).
• 2009 Two-year master in Marketing and Communication at the “Sole 24 Ore Business School” , Milan (I).
• 1982-1989 Researcher at the Institute of Diving and Hyperbaric Research and Studies in Naples and member of Interdisciplinary Hyperbaric Medical School of Naples (SIMIN).
• 1989 Medical Director of the Hyperbaric Centre of Ravenna, part of the Local Health Unit of Ravenna Emergency Department (118).
• 1990 till now, Medical commission Coordinator of the Italian Diving Activities Federation (FIAS).
• 1993 till now, Medical representative for Italy in the European Diving Technology Committee (EDTC) and member of EDTC Executive Committee.
• 1996 till now, Italian Diving and Hyperbaric Medical Society executive committee member (SIMSI).
• 1997 till now, Member of the Medical Committee of the Fire Department’s Divers Unit (Home Affairs Department)
• 1998 till now, Member of European Committee on Hyperbaric Medicine (ECHM) and EDTC Technical and Training.
• 1999-2004, Italian representative in the Management Committee and in Action COST B14 Hyperbaric oxygen therapy of the EU Directorate General XII for Scientific and Technological Research and University Ministry (MURST).
• 2003 till now, European Committee for Hyperbaric Medicine (ECHM) Scientific Commission member.
• 2005 till now, Member of Diving Medical Technology Committee (DMAC)
• 2007, Member of the UNI work group for regulations on commercial diving safety.
• 2007-2012-2017, Basic Offshore Safety Induction and Emergency Training course (included Helicopter Underwater Emergency Training and Emergency Breathing System) OPITO approved – Aberdeen (UK) / Mezzano (Ravenna, Italy)
• 1998-2006: Visiting professor at Postgraduate School in Underwater and Aquatic activities at Chieti University.
• 2006 till now, Affiliated Researcher Institute for Life Sciences, visiting professor and coordinator for hyperbaric area at University Master in Hyperbaric and Diving Medicine of the Superior School for Advanced Studies (Scuola Superiore Sant’Anna) of Pisa (Italy) .
• 2006 till now, Italian Contractors Association (AISI) medical commission coordinator.
• 2009, Awarded the “Tridente d’Oro” of the International Academy of Underwater Sciences and Techniques.
• 2010, Member of Italian Underwater Scientific Operators Association scientific committee (AIOSS) 2016 – 2020 President of the Italian Diving and Hyperbaric Medicine Society (SIMSI, www.simsi.it)
• 2016 - 2022External Advisor of World Union of Wound Healing Societies (WUWHS) – Executive Board
• 2017 San Paolo Prize awarded for “the continuous and constant contribution to the safety and the health of the Underwater Technicians, for the high degree of professionalism achieved in the delicate sector of underwater and hyperbaric medicine with international mandates, teaching and counselling activities in Italy and abroad, author of world-class scientific publications.
• His professional experiences, joined to his high humaneness, place him among the most authoritative names of the Italian underwater and hyperbaric medicine and among those who have most contributed to the culture of the safety regulation and the accident-prevention during underwater activities, both, in the professional and in the recreational field”.
• Commercial diving medical consultant for the following contractors: CNS International, Avenza – Carrara (I); CSS-SUBSEA (Suisse); Marine Consulting (I); Micoperi (I); RANA Diving and Marine Contractor.
• He takes part in: The Historical Diving Society Italy – founding partner; F.I.A.S. instructor-teacher; Confédération Mondiale des Activités Subaquatiques (C.M.A.S.) 3 stars instructor; DAN Oxygen First Aid Instructor – Trainer; JJ Level 1 Circuit Rebreather (CCR); PTA Deep Air; GUE Fundamentals; UTD Tek-1; SCUBA GYM 1 star instructor C.M.A.S; Aquatek SCR 1 (semi closed rebreather 1st level)

Anders Kjellberg, MD

PhD Student/ICU Consultant, Head of Hyperbaric unit, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm

Medical examinations

• 2013 European Diploma of Intensive Care Medicine (EDIC)
• 2009 Diplomate of European Society of Anaesthesiology (DESA)
• 2009 Specialist, Anaesthesia and Intensive Care
• 2001 Licence to practice
• 1999 Medical School, Göteborg University

Other relevant academic education and research education

• 2018-2020 KI Clinical Research school (molecular medicine),18HEC, Karolinska Institutet
• 2017 Laboratory Animal Science Function A- Rodents and lagomorphs, 3HEC, KI

Positions and assignments

• 2019- PhD Student, Dept Physiology and Pharmacology, Karolinska Institutet, Stockholm
• 2017- Consultant ICU/Head of Hyperbaric unit, Perioperative medicine and Intensive Care, Karolinska University Hospital, Stockholm
• 2013-2016 Specialist ICU, ANOPIVA, Karolinska University Hospital, Stockholm
• 2011-2013 Senior Registrar ICU, Flinders Medical Centre, Adelaide, Australia
• 2009-2011 Specialist Anaesthesia/ICU, VO Anaesthesia and Intensive Care, South Hospital
• 2005-2009 Resident, VO Anaesthesia and Intensive Care, South Hospital, Stockholm
• 2002-2010 Diving physician, Swedish Armed Forces (part time)
• 1991-1993 Communications officer, HM Submarine Näcken, Swedish Armed Forces

Publications:

1. Oscarsson N, Müller B, Rosén A, Lodding P, Mölne J, Giglio D, Hjelle K, Vaagbø G, Hyldegaard O, Vangedal M, Salling L, Kjellberg A, Lind F, Ettala O, Arola O, Seeman-Lodding H. Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2-3 trial. Lancet Oncol. 2019.
2. Kjellberg A, Nystrom H, Soderberg M, Dlugosz A, Jornvall H, Steinberg A. Massive air embolism as a complication of upper gastrointestinal endoscopy: A case report illustrating a stroke mimic, literature review, and suggested management. Clin Case Rep. 2018;6(9):1862-1867.

Kerry Thibodeaux, MD

Dr. Kerry Thibodeaux, a nationally recognized wound care advocate, is a Board Certified General Surgeon, Vascular Surgeon and Wound Care Specialist. Dr. Thibodeaux is a Fellow of the American College of Surgeons.

Dr. Thibodeaux graduated Magna Cum Laude in 1982 from the University of Southwestern Louisiana with a Bachelor of Science in a dual major of Biology & Chemistry.

Dr. Thibodeaux underwent his medical training at and graduated from the LSU School of Medicine in New Orleans in 1986. He then completed a 5 year General Surgery Residency at the LSU School of Medicine in New Orleans, While in his Residency program, Dr. Thibodeaux was the 1990 Surgical Teaching Resident and the Clinical Instructor of Surgery from 1989-1991. During the course of his studies at LSU School of Medicine, he received an NIH Grant for Wound Healing Research in 1987, which resulted in the publication of a wound healing article in the Southern Medical Association Journal.

Dr. Thibodeaux is the founder and Medical Director of The Wound Treatment Center, located within Opelousas General Health System. Dr. Thibodeaux serves as the Corporate Medical Director of Wound Care for LHC Group, Inc. Additionally, he serves as an inaugural member of the Clinical Advisory Board of Molnlycke Health Care. He is also a member of the Editorial Advisory Board for the peer-reviewed journal, WOUNDS, in addition to being a member of a variety of national and international Advisory Boards and Speakers’ Bureaus related to advanced wound care.

Dr. Thibodeaux has presented an Abstract and Poster entitled “Combined Therapy for Venous Leg Ulcers Using Hyperbaric Oxygen Therapy and Apligraf” at the 1999 International Undersea & Hyperbaric Medical Society Meeting in Boston, Massachusetts. Further, Dr. Thibodeaux presented a Poster entitled “Sepaderm for the Management of Acute and Chronic Wounds” at the SAWC Meeting in April of 2010 in Orlando, Florida. Dr. Thibodeaux, along with co-author S. William Tam, PhD, published a case series entitled “Sepaderm for the Management of Acute and Chronic Wounds” in the October 2010 edition of WOUNDS.

Since 1992, Dr. Thibodeaux has been in private practice specializing in General, Thoracic, Vascular, Endoscopic and Trauma Surgery in Opelousas, Louisiana.

Dr. David C. Lee

Dr. David C. Lee is a board certified emergency medicine physician and NIH-funded academic researcher at the NYU School of Medicine. His prior research experience includes mathematical modeling of infectious diseases, analyzing patterns of emergency department use during disasters, and geospatial analyses of chronic disease burden. He has currently been leading several emergency department based projects related to COVID-19. With Dr. Gorenstein, he helped to perform the safety study of hyperbaric oxygen therapy for COVID-19 patients at NYU Winthrop Hospital.

Objectives:

1. Understand the preliminary results of the NYU study of hyperbaric oxygen therapy for COVID-19 patients.
2. Comprehend the limitations of the data and what the implications of the study are for COVID-19 patients.

Technical Requirements

• Computer with internet connection and a modern, updated browser
• Note: If using IE 6, IE 7, or IE 8 we cannot guarantee that the courses will work.
• Audio speakers to listen to the lectures
• Keyboard to take the quizzes
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