Hyperbaric Oxygen Therapy (HBOT)

After TBI

Hyperbaric oxygen therapy (HBOT) involves breathing 100% (pure) oxygen while in a space called a hyperbaric chamber. The air we normally breathe is 21% oxygen. The air pressure inside the hyperbaric chamber is raised to a level that is higher than normal air pressure. Under these conditions, your lungs collect much more oxygen than they collect at normal air pressure. This allows five to ten times more oxygen to get into the blood stream and enter the tissues, including the brain. Getting more oxygen to the tissues that need it can help reduce inflammation and help the body to heal.

Hyperbaric oxygen therapy (HBOT) is known for treating deep-sea divers for decompression sickness. It is also used to treat carbon monoxide poisoning and severe wounds. Recently it has been studied in patients with traumatic brain injury (TBI).

Persistent post-concussion syndrome after mild TBI is a significant public health problem for which there is limited treatment. The primary brain injury is often exacerbated by secondary injury, including inflammation. HBOT can reduce inflammation and is being explored for treatment of TBI.

Some studies have shown benefits of HBOT after mild TBI in the chronic phase. One study looked at 63 patients who had a mild TBI at least six months previously. The patients were split into two groups, one that received HBOT and one that did not. The HBOT group received 40 treatment HBOT sessions. The group which received the HBOT showed greater improvements in memory and other cognitive functions as well as improvements in depression and anxiety. The improvements lasted at least a few months.

Another study showed that HBOT given acutely after injury may promote recovery of neurological function and improve the cognitive function and prognosis of patients with severe traumatic brain injury.

What might HBOT actually do in the brain? We don’t know for sure, and it is complicated. But it does reduce inflammation. Again, inflammation can cause secondary injury to the brain after the initial injury. HBOT likely improves the function of mitochondria. Mitochondria generate most of the chemical energy needed to power the cell’s biochemical reactions. Without mitochondria, cells do not function, and they die. HBOT may improve blood flow to the brain, promote the growth of stem cells and build antioxidant pathways.

HBOT is relatively expensive. The average cost of HBOT in the United States is around $250 per treatment and often 40 treatments are recommended.

HBOT is a promising treatment for traumatic brain injury. However, even though some studies have shown the benefit of HBOT after brain injury, we still have a lot to learn. For instance, do the improvements last for longer than a few months?

References:

Identifying the Target Traumatic Brain Injury Population for Hyperbaric Oxygen Therapy. Int J Mol Sci. 2023 Sep 27;24(19):14612. Samantha Schimmel, Bassel El Sayed, Gavin Lockard, Jonah Gordon, Isabella Young, Francesco D’Egidio, Jea Young Lee, Thomas Rodriguez, Cesar V Borlongan. Int J Mol Sci. 2023 Sep 27;24(19):14612.

Hyperbaric Oxygen Treatment — From Mechanisms to Cognitive Improvement. Irit Gottfried, Nofar Schottlender, and Uri Ashery. Biomolecules. 2021 Oct; 11(10): 1520.

Hyperbaric oxygen therapy for mild traumatic brain injury persistent postconcussion syndrome: a randomized controlled trial. Harch PG, Andrews SR, Rowe CJ, Lischka JR, Townsend MH, Yu Q, Mercante DE. Med Gas Res. 2020 Jan-Mar;10(1):8–20.

Hyperbaric oxygen for severe traumatic brain injury: a randomized trial.

Zhong X, Shan A, Xu J, Liang J, Long Y, Du B. J Int Med Res. 2020 Oct;48(10):300060520939824.

Hyperbaric Oxygen Therapy in the Treatment of Acute Severe Traumatic Brain Injury: A Systematic Review. Daly S, Thorpe M, Rockswold S, Hubbard M, Bergman T, Samadani U, Rockswold G.J Neurotrauma. 2018 Feb 15;35(4):623–629.