Authors' recommendations: Conclusions: Traumatic brain injury. The systematic reviews by McDonagh (2003) and Bennett (2004) provide the most rigorous and current information on the status of the clinical research for the use of HBO2 in TBI. Subsequent reviews identified these two reviews as the primary basis for their conclusions. To summarize their results, the clinical value of HBO2 in treating TBI is unknown due to insufficient evidence proving its effectiveness or ineffectiveness. Several case reports suggest positive outcomes for patients with TBI, but these studies were inconclusive for determining effectiveness as they were not randomized, controlled, or blinded studies. Therefore, it is unknown whether individual case reports of recovery are due directly to HBO2 therapeutic benefit, or natural recovery of each individual. The degree to which placebo effect may account for both symptom and imaging improvement in delayed treatment reports remains unknown. Promising results from animal studies have not as yet translated to humans. High quality research is needed to determine clinical efficacy of HBO2 in TBI treatment.TAP’s updated searches uncovered one recently published Phase II trial (See Table 3 below; NCT00170352). This study assessed evaluated the use of HBO2 and 100% FiO2 (fraction of inspired oxygen delivered) separately and in combination compared with standard care in a cohort of ventilated subjects with an acute severe TBI (GCS score ≤ 8) within 24 hours of injury. Subjects received hyperoxia treatments every 24 hours for three treatment sessions. HBO2 delivered to achieve a brain tissue P02 > 200 mm Hg has a greater positive effect than normobaric hyperoxia therapy on oxidative cerebral metabolism and intracranial pressure. Effect was sustained for at least six hours post treatment over the course of three treatment sessions without pulmonary or cerebral oxygen toxicity. Results suggest hyperoxia treatment in subjects with early, severe TBI may be safe and efficacious, and several clinical trials are in progress that may help inform these results (see Table 3). However, improvement in mortality or morbidity over the long-term requires further study. Conclusions: Post traumatic stress disorder. As only one case report was identified, the threshold for rigorous evidence of effectiveness for the treatment of PTSD with HBO2 has not been met. Existing evidence in the published research and popular press comprises anecdotes of promise and potential for this technology at times by proponents of HBO2 with financial and professional interests. Unbiased, independent research assessing the safety, feasibility and relative effectiveness of HBO2 is needed especially in a cohort of Veterans whose treatment options may otherwise be limited.

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/HBOTBIiPTSD2010tagm.pdf

Year Published: 2010

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: VA Technology Assessment Program (VATAP)