What is the role of hyperbaric oxygen therapy (HBOT) in the treatment of traumatic brain injury?

Updated: Nov 16, 2020
  • Author: Emi Latham, MD, FACEP, FAAEM, UHM; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Millions of people in the United States suffer from traumatic brain injuries every year. Currently, there is no known effective treatment, leaving patients with cognitive, behavioral, and communicative deficits. HBOT has been considered a possible treatment for brain injury since the 1960s. Many of the earlier trials and anecdotal reports did not suggest HBOT improved outcomes. These earlier trials have been criticized for lacking control of time from injury to treatment, treatment protocol, and a consistent way to assess patient outcomes.

The HBOT mechanisms proposed to help include increasing tissue oxygenation, reducing inflammation, decreasing apoptosis, reducing intracranial pressure, and promoting neurogenesis and angiogenesis. There are some reports that HBOT produces short-term improvement in postconcussive and posttraumatic stress disorder symptoms. In addition, there is self-reported improvement in cognitive processing speed and sleep. Currently, there is a large phase II multicenter trial evaluating the effects of HBOT on brain injury. The Hyperbaric Oxygen Brain Injury Treatment (HOBIT) trial is evaluating 8 different arms of treatment and is using a very specific scale to assess patient outcomes. There are also very strict protocols, including how long from time of injury treatments are initiated as well as depth and total time of treatment.

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