AUTHOR=Harch Paul G. 

TITLE=Systematic Review and Dosage Analysis: Hyperbaric Oxygen Therapy Efficacy in Mild Traumatic Brain Injury Persistent Postconcussion Syndrome

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.815056

DOI=10.3389/fneur.2022.815056

ISSN=1664-2295

ABSTRACT=This review evaluates the efficacy of hyperbaric oxygen therapy (HBOT) in adult mild traumatic brain injury Persistent Postconcussion Syndrome with or without Post Traumatic Stress Disorder based on immediate post-treatment symptomatic or cognitive outcomes and the dose of HBOT delivered.  PubMed, CINAHL, and the Cochrane Systematic Review Database were searched for all adult clinical studies published in English using the following terms:  hyperbaric oxygen and:  traumatic brain injury, mild traumatic brain injury, postconcussion syndrome, post concussion syndrome, persistent postconcussion syndrome, or persistent post concussion syndrome.  Randomized trials and studies with symptomatic and cognitive outcomes were selected for final analysis..  Of 681 articles searched 20 met criteria for inclusion.  After exclusion of subset publications of the randomized trials 11 studies were analyzed:  six randomized trials, two case series, and three case reports.  Whether analyzed by oxygen, pressure, or composite oxygen and pressure dose of hyperbaric therapy statistically significant symptomatic and cognitive improvements were achieved for patients treated with 40 HBOTS at 1.5 atmospheres absolute (ATA) (three studies) and 30 treatments at 1.3 ATA air (one study).  Conflicting results were obtained at 1.2 ATA air (one positive and one negative study) and negative effects at 2.4 ATA oxygen.  Conclusion:  In multiple randomized and randomized controlled studies HBOT at 1.5 ATA oxygen or 1.3 ATA air demonstrated statistically significant symptomatic or cognitive improvement in patients with mild traumatic brain injury Persistent Postconcussion Syndrome.  Improvements were greater when patients had comorbid Post Traumatic Stress Disorder.  These studies meet Level I evidence-based medicine criteria and constitute a Class A Recommendation for treatment.