The National Brain Injury Rescue and Rehabilitation Study - a multicenter observational study of hyperbaric oxygen for mild traumatic brain injury with post-concussive symptoms

The National Brain Injury Rescue and Rehabilitation Project was established as a preliminary study to test the safety and practicality of multi-center hyperbaric oxygen administration for the post-concussive symptoms of chronic mild traumatic brain injury as a precursor to a pivotal, independent, multi-center, controlled clinical trial. This report presents the results for 32 subjects who completed a preliminary trial of hyperbaric oxygen several years before the passage of the 21 ^st Century Cures Act. This study anticipated the Act and its reassessment of clinical research. Subjects received 40-82 one-hour treatments at 1.5 atmospheres absolute 100% oxygen. Outcome measures included repeated self-assessment measures and automated neurocognitive tests. The subjects demonstrated improvement in 21 of 25 neurocognitive test measures observed. The objective neurocognitive test components showed improvement in 13 of 17 measures. Earlier administration of hyperbaric oxygen post injury, younger age at the time of injury and hyperbaric oxygen administration, military status, and increased number of hyperbaric oxygen administrations were characteristics associated with improved outcomes. There were no adverse events. Hyperbaric oxygen was found to be safe, inexpensive and worthy of clinical application in the 21 ^st Century model of facile data collection provided by recent research regulatory shifts in medicine. The study was approved by the ethics review committee of the Western Institutional Review Board (WIRB; Protocol #20090761).

All the right moves: the need for the timely use of hyperbaric oxygen therapy for treating TBI/CTE/PTSD

Background

The modern age of hyperbaric medicine began in 1937; however, today few know about hyperbaric oxygen’s effects on the body and medical conditions outside of diving medicine and wound care centers - a serious ethical issue as there are 20 US military veterans committing suicide every day directly related to Traumatic Brain Injury/Post Traumatic Stress Disorder. The problem is not whether hyperbaric oxygen is effective for treating brain injuries, but why the interference in offering this therapy to those who need it.

Discussion

Up against black-boxed anti-depressants that are not efficacious, it should be a “no-brainer” to use a safe, off-label drug, but in the case of military veterans, every suicide might be seen as a tremendous cost saving to certain technocrats. The unspoken rationale is that if the military were to embrace hyperbaric oxygen as the efficacious therapy that it is then current active troops that have suffered injuries will come forward and seek treatment and benefits for their Traumatic Brain Injuries now that they know there is a viable therapy and in so doing troop strength will be decimated. So, to attempt to delay the acceptance of hyperbaric oxygen the Department of Defense has funded faux-studies claiming low pressure room air to be a placebo or sham, and then proclaiming there is no statistical difference between treatment arms and sham or placebo treatment arms. With few who understand hyperbaric medicine there is almost no one to call them on this subterfuge and prevarication. Many peer-reviewed articles have been published in the last decade that demonstrate hyperbaric oxygen is effective in repairing an injured brain even long after that injury took place. One of the most notable showed that blast-induced brain injured war veterans experienced a 15 point IQ increase (p < 0.001).

Summary

Hyperbaric oxygen is an efficacious, benign and humanitarian way to affect brain repair but it has not been adopted because it lacks patent protection and has no large corporate sponsors. It has also met interference because other agendas are present be they the protection of the status quo, myopic budgetary constraints, or perceived liability issues.

Hyperbaric oxygen therapy (1.5 ATA) in treating sports related TBI/CTE: two case reports

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.

Hyperbaric oxygen and carbon monoxide poisoning: a critical review

CO is likely to be the most common cause of poisoning worldwide and often results in persistent neuropathologic and cognitive sequelae. While the displacement of oxygen from hemoglobin by CO has overshadowed the myriad mechanisms by which CO causes injury, mere oxygen displacement has endured as the etiology of CO poisonings and perpetuated a cascade of misdiagnosis, misunderstandings and confusion regarding how and when to treat CO poisoning. Hyperbaric oxygen benefits the brain more than normobaric oxygen by, e.g. improving energy metabolism, preventing lipid peroxidation and decreasing neutrophil adherence. Randomized controlled trials have definitively shown hyperbaric oxygen as the only efficacious therapy for acute CO poisoning if delayed neurological sequelae are to be minimized. Normobaric oxygen should not be used between multiple hyperbaric oxygen treatments as this can contribute to toxicity. Hyperbaric oxygen seems to also have potential in the delayed treatment of CO poisoning using multiple treatments of low dose of oxygen; however, oxygen dosing issues are not yet fully understood for either acute or delayed treatment. It would behoove medical decision-makers to embrace this important tool and make it more accessible as well as helping to disseminate to the medical community what is now known from the available literature.

Quantification of neurocognitive changes before, during, and after hyperbaric oxygen therapy in a case of fetal alcohol syndrome

Fetal alcohol syndrome (FAS) is the most common nonhereditary cause of mental retardation, with deficits in general intellectual functioning, learning, memory, attention, and problem-solving. Presented here is the first case in which measured neurocognitive abilities were determined before, during, and after hyperbaric oxygen therapy in a case of FAS involving a teenage male patient. Memory, reaction time, and visual motor speed assessments were compared. After 40 hyperbaric treatments with 100% oxygen at 1.5 atmospheres absolute, the patient's performance in 6 of 6 categories of the computer-administered test battery improved. Word composite (verbal) scores improved from 55% to 73%, memory composite (visual) scores improved from 38% to 55%, reaction time composites improved from 1.03 to 0.53 seconds, impulse control composite scores improved from 8 to 5, and visual motor speed scores improved from 18.6 to 19.03. The patient's subjective symptoms diminished 94%. Six months after these treatments, the patient's verbal memory was maintained at 73% without any other interventions; impulsivity continued to improve, whereas other indices did not. Thirty-three additional treatments continued to improve test performance, with verbal memory at 95%, visual memory at 57%, and a 100% reduction of subjective symptoms. This patient, with 15-year-matured FAS, benefited from a short course of low-pressure hyperbaric oxygen therapy, sustained durable cognitive improvements, and continued to exhibit improvement with another short course of treatments.

Remote physiological sensing: historical perspective, theories and preliminary developments

Many physiological processes are characterized by the generation and propagation of multiple, dynamic, infinitely variable, and often transient electrical phenomena in the respective tissues and organs where they originate. The purpose of physiological recording is to obtain a record that is an exact facsimile or analog of the events under investigation. However, since it is seldom feasible to attach pickup elements directly to the tissues or organs being investigated, some method of sensing the reflections and projections of the phenomena from the surface of the body must usually be employed. Such methods always introduce measurement errors that result in a distorted picture of the processes being recorded. In spite of this limitation, these techniques have proven highly useful for the medical and allied professions. As a result of the transition of medicine from a descriptive to an analytical science, a wide variety of pickup elements of various sophistication have been developed and are presently available for recording many important phenomena associated with various physiological functions from different anatomical sites. With the exception of the electrocardiogram (ECG), electroencephalogram (EEG), and electromyogram (EMG), other forms of biomonitoring have not yet achieved the acceptance necessary to allow their full development. It would seem that the development of the ECG, EEG, and EMG are reaching toward a plateau, and other forms of biomonitoring techniques are required to interpret physiological changes and parameters.

Intranasal airway/pack: description of a new device

We have designed and developed a new intranasal pack which has been found to be most effective in controlling anterior and posterior epistaxis. Its ease of introduction and patient tolerance make it ideal for treating posterior epistaxis on an outpatient basis, and as packing for septal, sinus, or rhinoplastic surgery. The unique features of a breathing cannula and total intranasal tamponade distinguish this device from all preceding ones.