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Covid19HBOTpCOVIDNCT04647656

Hyperbaric Oxygen Therapy for Post-COVID-19 Syndrome

A study testing Hyperbaric oxygen in people with Covid19 and Neurocognitive Dysfunction, run by Assaf-Harofeh Medical Center at 1 site in Israel.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial 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. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Covid19, Neurocognitive Dysfunction
What is being tested?
Hyperbaric oxygen
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
91 participants
Where
1 siteIsrael
Study dates
1 Jun 2023to 31 Dec 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

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

Who cannot join

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

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Shani Zilberman-Itskovich, Dr. contact

97289979383

shani.zilberman@mail.huji.ac.il

Shai Efrati, Prof. contact

efratishai@outlook.com

Israel1 site, 1 recruiting
  • Assaf-Harofeh medical center

    Tsrifin, 70300

    Shani Zilberman-Itskovich, Dr., +97289979383, shani.zilberman@mail.huji.ac.il

    Recruiting

Other trials in Israel

About this study

Official title: Hyperbaric Oxygen Therapy for Post-COVID-19 Syndrome: a Prospective, Randomized, Double Blind Study.

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

Read the 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.

Being tested
Hyperbaric oxygen, Sham
Medical subject headings
COVID-19, Cognition Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Hyperbaric oxygenDevice

    Each session will include exposure of 90 minutes to 100% at 2 ATA, with 5 minutes air breaks every 20 minutes

  • ShamDevice

    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

Study groups in NCT04647656
Study groupRoleWhat they receive
HBOT treatment groupActive comparator40 daily hyperbaric oxygen treatment sessions will be administered 5 days per week
Receives: Device: Hyperbaric oxygen
HBOT sham groupSham comparator40 daily Sham non-hyperbaric oxygen treatment will be administered 5 days per week
Receives: Device: Sham

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Cognitive health assessment (NeuroTrax)

    Memory, attention and information process will be evaluated using the NeuroTrax computerized cognitive evaluation battery.

    Measured: Baseline, 2 months

Secondary outcomes (15)
  1. Brain perfusion

    Cerebral blood volume and flow will be measured using perfusion MRI protocol Dynamic susceptibility contrast (DSC).

    Measured: Baseline, 2 months

  2. Brain microstructure Brain microstructure

    Fractional anisotropy (FA) and Mean diffusivity (MD) will be evaluated using diffusion tensor imaging (DTI) MRI protocol

    Measured: Baseline, 2 months

  3. Brain function imaging

    Resting state fMRI (rsfMRI), and task based fmri will evaluate brain function during a working memory task

    Measured: Baseline, 2 months

  4. Post-COVID-19 symptom

    Self-reported questionnaire covers the most common symptoms related to post-coronavirus 2019 (COVID-19) disease

    Measured: Baseline, 2 months

  5. Quality of Life SF-36

    Short Form (SF)-36 questionnaire for self reporting quality of life

    Measured: Baseline, 2 months, 1 year

  6. The Pittsburgh Sleep Quality Index PSQI

    The Pittsburgh Sleep Quality Index (PSQI) is a self-report questionnaire that assesses sleep quality

    Measured: Baseline, 2 months, 1 year

  7. The Brief Symptom Inventory - 18 (BSI-18)

    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

    Measured: Baseline, 2 months, 1 year

  8. BPI - Brief pain inventory (short form)

    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.

    Measured: Baseline, 2 months, 1 year

  9. Neuro-physical evaluation

    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).

    Measured: Baseline, 2 months

  10. Neurological evaluation

    The neurological exam will include tests of the cranial nerves, motor, sensory and cerebellar function and gait

    Measured: Baseline, 2 months

  11. Smell and taste evaluations.

    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").

    Measured: Baseline, 2 months

  12. Cardiopulmonary exercise test

    The cardiopulmonary exercise test (CPET) is a non-invasive measurement of the cardiovascular system, respiratory system and muscles.

    Measured: Baseline, 2 months

  13. Echocardiography

    Conventional echocardiography evaluation, linear, volumetric and Doppler measurements will be performed to assess cardiac functions.

    Measured: Baseline, 2 months

  14. Lung functions test

    Measurements of pulmonary functions will be performed using spirometry (the MiniSpir) testing apparatus.

    Measured: Baseline, 2 months

  15. Immune system

    Blood tests will evaluate immune system including cytokines, c-reactive protein (CRP) and COVID-19 antibodies

    Measured: Baseline, 2 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Dec 2020
  2. Study start1 Jun 2023
  3. Primary completion31 Dec 2027 (estimated)
  4. Study completion31 Dec 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
91 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04647656
Sponsor's protocol ID
0332-20-ASF
Acronym
HBOTpCOVID
Status last verified
Apr 2026
First submitted
29 Nov 2020
Last updated
21 Apr 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Stam HJ, Stucki G, Bickenbach J; European Academy of Rehabilitation Medicine. Covid-19 and Post Intensive Care Syndrome: A Call for Action. J Rehabil Med. 2020 Apr 15;52(4):jrm00044. doi: 10.2340/16501977-2677.

    PubMed 32286675
  • Carfi A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. doi: 10.1001/jama.2020.12603.

    PubMed 32644129
  • Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, Doucet L, Berkani S, Oliosi E, Mallart E, Corre F, Zarrouk V, Moyer JD, Galy A, Honsel V, Fantin B, Nguyen Y. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020 Dec;81(6):e4-e6. doi: 10.1016/j.jinf.2020.08.029. Epub 2020 Aug 25.

    PubMed 32853602
  • Tal S, Hadanny A, Berkovitz N, Sasson E, Ben-Jacob E, Efrati S. Hyperbaric oxygen may induce angiogenesis in patients suffering from prolonged post-concussion syndrome due to traumatic brain injury. Restor Neurol Neurosci. 2015;33(6):943-51. doi: 10.3233/RNN-150585.

    PubMed 26484702
  • Boussi-Gross R, Golan H, Fishlev G, Bechor Y, Volkov O, Bergan J, Friedman M, Hoofien D, Shlamkovitch N, Ben-Jacob E, Efrati S. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury - randomized prospective trial. PLoS One. 2013 Nov 15;8(11):e79995. doi: 10.1371/journal.pone.0079995. eCollection 2013.

    PubMed 24260334
  • Leitman M, Fuchs S, Tyomkin V, Hadanny A, Zilberman-Itskovich S, Efrati S. The effect of hyperbaric oxygen therapy on myocardial function in post-COVID-19 syndrome patients: a randomized controlled trial. Sci Rep. 2023 Jun 10;13(1):9473. doi: 10.1038/s41598-023-36570-x.

    PubMed 37301934

Questions about this trial

What is this clinical trial studying?

A study testing Hyperbaric oxygen in people with Covid19 and Neurocognitive Dysfunction, run by Assaf-Harofeh Medical Center at 1 site in Israel.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 21 Apr 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Israel. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Shani Zilberman-Itskovich, Dr. (97289979383, shani.zilberman@mail.huji.ac.il), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Cognitive health assessment (NeuroTrax) (time frame: Baseline, 2 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04647656, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Apr 2026.

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Hyperbaric Oxygen Therapy for Post-COVID-19 Syndrome | AzTrials