Effect of hyperbaric oxygen on patients with traumatic brain injury

Department of Neurosurgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
Acta neurochirurgica. Supplement 01/2008; 101(101):145-9. DOI: 10.1007/978-3-211-78205-7_25
Source: PubMed


Hyperbaric oxygen therapy (HBOT) is the medical therapeutic use of oxygen at a higher atmospheric pressure. The United States Food and Drug Administration have approved several clinical applications for HBOT, but HBOT in traumatic brain injury (TBI) patients has still remained in controversial. The purpose of our study is to evaluate the benefit of HBOT on the prognosis of subacute TBI patients. We prospectively enrolled 44 patients with TBI from November 1, 2004 to October 31, 2005. The study group randomly included 22 patients who received HBOT after the patients' condition stabilization, and the other 22 corresponding condition patients were assigned into the matched control group who were not treated with HBOT. The clinical conditions of the patients were evaluated with the Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) before and 3 to 6 months after HBOT. The GCS of the HBOT group was improved from 11.1 to 13.5 in average, and from 10.4 to 11.5 (p < 0.05) for control group. Among those patients with GOS = 4 before the HBOT, significant GOS improvement was observed in the HBOT group 6 months after HBOT. Based on this study, HBOT can provide some benefits for the subacute TBI patients with minimal adverse side effects.

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    • "With the exception of improvements in the Trouillas and the Orgogozo scale scores found by Nighoghossian et al. after 1 year of HBO treatment, all other studies have reported mainly negative results. Similarly, many studies have demonstrated that HBO treatment increases Glasgow Coma Scale and Glasgow Outcome Scale scores (Ren et al. 2001, Xie et al. 2007, Lin et al. 2008) in TBI patients. However , the existing data do not justify the use of HBO therapy in neither condition due to the lack of significant effects possibly related to the small number of patients, to delays in initiating HBO therapy and to absence of successful blinding among the main literature (Liu et al. 2011). "
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    ABSTRACT: Aim: Hyperbaric hyperoxia (HBO) is known to modulate aerobic metabolism, vasoreactivity and blood flow in the brain. Nevertheless, mechanisms underlying its therapeutic effects, especially in traumatic brain injury (TBI) and stroke patients, are debated. The present study aimed at investigating regional cerebral blood flow (rCBF) distribution during acute HBO exposure. Methods: Regional cerebral blood flow response was investigated in seven healthy subjects exposed to either normobaric normoxia or HBO with ambient pressure/inspired oxygen pressure of 101/21 and 250/250 kPa respectively. After 40 min at the desired pressure, they were injected a perfusion tracer and subsequently underwent brain single photon emission computed tomography. rCBF distribution changes in the whole brain were assessed by Statistical Parametric Mapping. Results: During HBO, an increased relative rCBF distribution was found in sensory-motor, premotor, visual and posterior cingulate cortices as well as in superior frontal gyrus, middle/inferior temporal and angular gyrus and cerebellum, mainly in the dominant hemisphere. During normobaric normoxia, a higher (99m) Tc-HMPAO distribution in the right insula and subcortical structures as well as in bilateral hippocampi and anterior cingulated cortex was found. Conclusions: The present study firstly confirmed the rCBF distribution increase during HBO in sensory-motor and visual cortices, and it showed for the first time a higher perfusion tracer distribution in areas encompassed in dorsal attention system and in default mode network. These findings unfold both the externally directed cognition performance improvement related to the HBO and the internally directed cognition states during resting-state conditions, suggesting possible beneficial effects in TBI and stroke patients.
    Acta Physiologica 05/2013; 209(1). DOI:10.1111/apha.12116 · 4.38 Impact Factor
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    • "Subjects were treated initially at an average of 28 days post-insult/injury with 20 treatments lasting 90 min each of 2.0 ATA. Despite enrollment at such a late time, they were able to demonstrate a significant benefit from 20 lasting 90 min each of 2.0 ATA HBO 2 T when baseline comparisons were made at 6 months post-treatment in the number of patients achieving a Glasgow Outcome Scale level of 4 (moderate disability) subgroup of the patients was evaluated [52]. At first glance this data might lead one to question why HBO 2 T is not now standard care for TBI. "
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    ABSTRACT: Introduction: There is great interest in using hyperbaric oxygen (HBO) to treat neurological disease. The exquisite sensitivity of neural tissue to hypoxia makes increased oxygenation attractive as a therapy for disease processes that induce ischemia, edema, and, more recently, apoptosis. Four things specifically exist as targets for future projects and clinical trials: (1) stroke (2) traumatic brain injury (3) radiation induced necrosis and (4) status migrainosus. Methods: Specific aims: Stroke: determine if the use of HBO in the treatment of acute ischemic stroke is effective at improving outcomes. TBI: determine whether use of HBO in the acute state after traumatic brain injury is effective at improving outcomes and reducing elevated ICP. RIN: determine whether HBO treatment of radiation necrosis of brain results in improvement of neurological function and reduction of necrosis. Migraine: determine whether use of HBO will relieve headache pain in status migrainosus. Results: Stroke: there is evidence from animal studies that focal cerebral ischemia may improve after HBO treatment. TBI: the interest in using HBO to treat TBI is based upon the premise that hypoxia, edema and apoptosis play significant roles in the pathophysiology of the disease. RIN: the evidence suggests that in cases where either the patient is not improving on medical therapies or when surgical resection is not possible, HBO should be considered as a treatment option. Migraine: there is some evidence looking at HBO as an effective treatment of acute migraine attack. Summary: Each is discussed further with proposed study design and justification for their respective parameters. As our action plan moving forward, it is our goal to investigate in each area with multidisciplinary, multi-centered, case controlled double blind crossover studies.
    Pediatria polska 09/2012; 87(5):429–437. DOI:10.1016/j.pepo.2012.08.001
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    • "In two airmen with pre-injury neuropsychiatric testing and chronic stable TBI symptoms, HBOT 1.5 resulted in resolution of symptoms as well as a return to the pre-injury values for testing [20]. In a randomized controlled trial of stable severe TBI treated with HBOT 1.5 Lin et al demonstrated improvement in the Glasgow Coma Scale [21]. Rockswold has demonstrated improvement in the Glasgow Coma Scale and reduced mortality in acute TBI patients undergoing HBOT with minimal risk [22,23]. "
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    ABSTRACT: Despite adequate evidence, including randomized controlled trials; hyperbaric oxygen is not yet recognized as efficacious for treating various forms of brain injury, specifically traumatic brain injury. Political-economic issues have kept this benign therapy from being widely adopted despite the lack of viable alternatives. Two football players with TBI/CTE are herewith shown to benefit from being treated with hyperbaric oxygen as documented by neurocognitive examinations and functional brain imaging, in one case treatment commenced decades after the brain injury. Perhaps the interest in HBOT by those participating in high-risk sports will help expand this orphan therapy into mainstream medicine.
    07/2011; 1(1):17. DOI:10.1186/2045-9912-1-17
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