Research Reports - Use of hyperbaric oxygen in traumatic brain injury: Retrospective analysis of data of 20 patients treated at a tertiary care centre

Br J Neurosurg. 2012 Apr;26(2):202-7. Epub 2011 Nov 15.

Sahni T, Jain M, Prasad R, Sogani SK, Singh VP.

Traumatic brain injury (TBI) related impact results in a permanent need
for help in performing daily activities. Standard treatment consists of removing
the cause, restore perfusion, support metabolic requirement and limit
inflammatory and oxidative damage. Hyperbaric oxygen therapy (HBOT) is one such
newer promising treatment that enhances neurological recovery to some extent.
HBOT is intermittent inhalation of 100% oxygen at greater than normal atmospheric
pressure and is internationally accepted for its role in well-defined
indications. It is hypothesised that HBO has a role in reviving 'idling neurons',
also called the ischemic penumbra defined as area of reduced cerebral blood flow,
abolished synaptic activity but preserved structural integrity. We carried out a
retrospective analysis of medical records of 20 patients of TBI who had been
treated with HBOT in addition to standard management. These were placed in Group
A (test group) and received at least 30 sessions of HBO along with standard
treatment. The patients were assessed along the Disability Rating Scale (DRS),
Glasgow coma scale (GCS) and Rancho Los Amigos Scale (RLAS). Another 20 patients
of TBI, matched in age and severity of brain injury, who received standard
treatment but not HBOT, were selected as the control group (Group B). Assessment
on the DRS showed maximum improvement in patients with scores of 22-24
(vegetative state).The percentage of patients in the test group fell from 45% to
5% whereas only 20% patients in Group B had similar progress. After the
treatment, a significantly higher proportion of HBOT treated subjects showed a
good response in cognitive functions, as measured by RLA. In group A, 90%
patients had a score of ≤ 3 and in Group B 95% had a similar score, which
improved to ≥ 3 in 60% patients versus 30% patients respectively. In both groups
maximum patients are in 1-6 months post-injury category and within the groups
this category showed the greatest recovery, with a greater improvement in the
test group as compared to control group.

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