Hyperbaric Oxygen May Benefit Traumatic Brain Injuries

[VentMedic]

This should go nicely with some of the other O2 topics. Or, it may confuse a few.

We have been using HBO to treat a variety of injuries and disease processes for many years.

Hyperbaric Oxygen May Benefit Traumatic Brain Injuries

via PRNewswire

http://www.emsresponder.com/article/article.jsp?id=11613&siteSection=1

MINNEAPOLIS, Jan. 4 /PRNewswire-USNewswire/ -- A 5-year study of patients with severe traumatic brain injury conducted at Hennepin County Medical Center in Minneapolis shows significant benefit of hyperbaric oxygen therapy to improve brain metabolism and its ability to recover from injury. The results were recently published in the Journal of Neurosurgery.

Every year, more than 1.4 million Americans sustain a traumatic brain injury (TBI) - the leading cause of death and disability in children and young adults. Those who survive often face months or even years of therapy, and sometimes the damage to the brain is irreversible. Decreased utilization of oxygenated blood to brain tissue immediately after the injury is often to blame.

Cells need oxygen to fuel metabolism for cellular growth and repair. Healthy brains produce their own energy to maintain brain tissue and keep the rest of the body doing what it's supposed to do. That includes automatic processes like breathing and circulation, as well as voluntary actions like walking and talking. After a traumatic brain injury, the brain itself needs care. Barriers to blood flow can be compromised from the impact of the injury itself, and then when the brain swells inside the skull, a secondary injury can occur that causes even more brain damage.

"There's a direct correlation between clinical outcome and the degree to which the brain's metabolism is restored," explains one of the study's authors, neurosurgeon Gaylan Rockswold, MD. "In previous research we learned that the brain's energy production is improved and maintained with hyperbaric oxygen treatment, but this study confirms that hyperbaric oxygen treatment has a major impact in terms of increased energy production."

Within 24 hours after injury, eligible patients for the study were randomized into three groups: One group received "normobaric" treatment: oxygen delivered at the patient's bedside; another group received hyperbaric treatment in Hennepin County Medical Center's hyperbaric oxygen chamber; and a third (control) group did not receive additional oxygen therapy. All groups received the intensive standard of care for brain injury consistent with good clinical practice. The patients

who received higher levels of oxygen (hyperoxia) via the hyperbaric oxygen chamber were found to have a marked increase in positive brain metabolism when compared to the normobaric and control group.

"Our goal was to evaluate the brain's metabolism and intracranial pressure, and whether or not too much oxygen posed a concern with hyperbaric oxygen treatment in these patients," said Dr. Rockswold. "The results indicate that hyperbaric oxygen treatment was found to significantly enhance the brain's energy production and reduce intracranial pressure without any toxic effects on the brain or lungs from too much oxygen."

This research provides important preliminary data for a National Institutes of Health (NIH) supported multicenter trial. NIH trials directly assess the ability to improve clinical outcomes, which is the final step needed to change standard clinical processes. Currently standard clinical practice does not include hyperbaric oxygen for traumatic brain injury.

"TBI is not only devastating for the patient, it's also heart wrenching for his or her family. We couldn't be more pleased about the impact this study will have for patients with traumatic brain injury."

The Traumatic Brain Injury Center at Hennepin County Medical Center offers comprehensive, multidisciplinary patient care education and research to serve people who have sustained a traumatic brain injury. Providing a full range of state-of-the-art medical and rehabilitative services, HCMC's expertise spans the entire continuum of care for adult and pediatric TBI patients, from prevention to emergency care, neurosurgery, critical care, rehabilitation and the Mild to Moderate Traumatic Brain Injury Clinic.

About Traumatic Brain Injuries

Each year, more than 1.5 million Americans sustain a traumatic brain injury (TBI). In Minnesota, nearly 100,000 brain injuries occur annually. A large percentage of those injuries are mild to moderate cases and often go untreated. As a Level 1 Trauma Center, Hennepin County Medical Center admits and treats the most traumatic brain injuries in the state. More information about HCMC's Traumatic Brain Injury Center can be found at www.savethisbrain.org.

The state's only permanent, fully accredited hyperbaric chamber is located at Hennepin County Medical Center. HCMC's Hyperbaric Medicine program is one of only 60 programs in the country to achieve accreditation by the Undersea and Hyperbaric Medical Society (UHMS).

The multi-chambered unit is fully staffed year round and is used for a variety of critical and chronic medical conditions, including treatment for carbon monoxide poisoning. Hennepin County Medical Center is a Level 1 Trauma Center and public teaching hospital repeatedly recognized as one of America's best hospitals by U.S. News & World Report.

http://www.emsresponder.com/article/article.jsp?id=11613&siteSection=1

[CBEMT]

Relative of mine had a baby born with cerebral palsy years back. They used hyperbaric therapy in an attempt to improve her cognition and function. I'm not close enough with them to know what the results were though.

[fireflymedic]

I was aware of them utilizing hyperbaric oxygen in "dummy foals" - baby horses born with neurologic damage with positive outcomes. Interesting to see how this progresses and if it becomes an industry standard. This seems to be a new field that is being explored for a variety of illnesses, and in theory it makes sense as improved oxygenation should improve function. Would be very interested though to see if it would have any effect on COPD patients. On the same token - I've been reading up on something in trial stages known as SLO - detoxified streptolysin O. Was used anecdotally on WTC victims that had significant lung injuries and also for burn victims and surgical patients for reduction of scars and adhesions. Is currently in very early stages, but wonder if it will progress out as a potential therapy to help those with COPD and ARDS ? Perhaps?

[VentMedic]

COPD patients can be tricky to dive in the chamber especially if they have blebs (bullous) or might be prone to pneumos. Also, the potential for increased mismatching could lead to some respiratory distress issues and an increase in PaCO2.

ARDS has many different components and it may be difficult to manage them on a ventilator designed for the chamber. The many meds they are on may also be a challege. As well, the development of ARDS can be a concern as the potential for O2 toxicity exists with HBO therapy. There is some irritation noted at 3-6 hours of exposure of 2 ATA oxygen and at 10 hours it can become intense.

[fireflymedic]

COPD patients can be tricky to dive in the chamber especially if they have blebs (bullous) or might be prone to pneumos. Also, the potential for increased mismatching could lead to some respiratory distress issues and an increase in PaCO2.

ARDS has many different components and it may be difficult to manage them on a ventilator designed for the chamber. The many meds they are on may also be a challege. As well, the development of ARDS can be a concern as the potential for O2 toxicity exists with HBO therapy. There is some irritation noted at 3-6 hours of exposure of 2 ATA oxygen and at 10 hours it can become intense.

Reference to COPD and ARDS were not for HBO therapy - I think you misunderstood as I combined two things there. I was referencing the SLO (detoxified streptolysin O) therapy stated in my post for those two conditions. I'm sorry if I didn't clarify that well. Please read back. This is info on it specific to respiratory conditions

http://www.beechtreelabs.com/productdevelopment/respiratorydisease.php

I was curious as to HBO for COPD in the aspect of increased oxygenation - though completely agree that you would have to be cautious with increased pressures, etc. Points well made across the board, just think you misunderstood my direction. Hope this clarified it some.