Hyperbaric Oxygen "Dives" Take Brain Injury Healing to New Depths

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Article for the Brain Injury Association of Georgia’s Brain Injury Resource Center website

by Richard W. King, Jr. M.D.

The wisdom of the author of the children’s book “The Little Prince”transcends building ships. Teaching patients to “long for the endless immensity of the sea” works both as a metaphor to reach the goal of wellness and as an analogy to prepare patients for the virtual descent to 45-feet below sea level during hyperbaric oxygen (HBO2) therapy.

Physicians refer patients for HBO2 treatment when their chronic, non-healing wounds and injuries can benefit from using oxygen as a drug. Since brain function is regulated by oxygen, the potential power of HBO2in treating traumatic brain injury (TBI) results from its delivery of 100 percent oxygen under pressure to tissues and cells by super-saturating the plasma.

After a complete medical evaluation, the TBI patient’s diagnosis, symptoms and overall condition are assessed to help determine treatment protocol. O2 dosage and treatment time for TBI patients is still debated in hyperbaric medicine circles. Although the use of HBO2 as an adjunctive therapy to traditional methods of TBI treatment and rehabilitation remains “off-label,” it’s gaining more recognition and ground among healthcare professionals.

During each one to two hour HBO2 treatment or “dive,” the hyperoxygenation received in the pressurized hyperbaric chamber enriches the patient’s blood to help regenerate tissues and in the case of an injured brain, can have a marked effect on blood flow. This benefit has been shown to reduce and improve a TBI patient’s neurological disability and accelerate the rehabilitation and healing process.

Cerebral edema or swelling is a major symptom of acute TBI. HBO2“attacks” the edema with high-pressure oxygen, which constricts blood vessels while simultaneously increasing oxygen to the injured area. A TBI patient case study chronicled by Dr. Richard A. Neubauer in the Southern Medical Journal revealed a “dramatic improvement in many of (the patient’s) cognitive functions” after an intensive course of HBO2 therapy. Dr. Neubauer’s study hailed the importance of “SPECT imaging before and after HBO2 therapy to identify potentially recoverable brain tissue, in monitoring the effectiveness of therapy and in helping to identify the end point of therapy.”1

Proponents for HBO2 believe consistent and frequent HBO2 treatment is effective for assisting TBI rehabilitation by:

  • Enhancing oxygen concentration in hypoxic areas of the brain
  • Promoting revascularization of ischemic areas
  • Reducing cerebral edema and intracranial pressure by causing constriction of the brain’s blood vessels
  • Reactivating idling neurons
  • Stimulating the growth of new blood vessels (angiogenesis) over time
  • Savaging free radicals
  • Restoring the integrity of the blood-brain barrier and cell membranes
  • Building the oxygen content in cerebrospinal fluid
  • Inhibiting reperfusion injury, or injury to tissues deprived of blood supply when blood flow is resumed
  • The benefits of HBO2 may vary according to various factors including the severity of TBI, the number of recoverable neurons and how soon the treatment commences after injury.

    Although HBO2 remains an “off-label” adjunctive treatment method for chronic TBI, its use is essential to the practice and progression of medicine. To better assess HBO2‘s effectiveness for TBI, more research is needed.

    Foundation funding is necessary as are patients willing to undergo HBO2treatment, which may have side effects including barotrauma, bruised eardrums and a higher risk for brain seizures from higher O2 pressure. The side effects are reduced or diminished by seizure medication and by clearing the ears while in the hyperbaric chamber.

    1 Neubauer, R.A., Southern Medical Journal, Journal of the Southern Medical Association, Volume 87, Number 9, Sept. 1994, Pages 933-936.

    About Dr. Richard (Rick) King

    Dr. KingThe Emory University School of Medicine graduate is board-certified in physical medicine and rehabilitation and in underseas and hyperbaric medicine. Combining a career in medicine and an avid interest in scuba diving led Dr. King to open HyOx Medical Treatment Center, a hyperbaric medicine and rehabilitation facility located in Atlanta.