Hyperbaric oxygen for moderate-to-severe traumatic brain injury: outcomes 5–8 years after injury

Zhang, Zhihua1,*; Li, Zhenwei2; Li, Shuyang1; Xiong, Bing1; Zhou, You1; Shi, Chaohong3.

¹Departments of Physical Medicine and Rehabilitation, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China²Department of Infection Control, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China³Departments of Physical Medicine and Rehabilitation, The First People’s Hospital of Wenling, Taizhou, Zhejiang Province, China

Abstract

The use of hyperbaric oxygen (HBO₂) in the field of traumatic brain injury (TBI) is becoming more widespread and increasing yearly, however there are few prognostic reports on long-term functional efficacy. The aim of this study was to assess the functional prognosis of patients with moderate-to-severe TBI 5–8 years following HBO₂ treatments and to explore the optimal HBO₂ regimen associated with prognosis, using a retrospective study. Clinical data were retrospectively collected as a baseline for patients with moderate-to-severe TBI treated with HBO₂ during inpatient rehabilitation from January 2014 to December 2017. The primary outcome measure was the Disability Rating Scale (DRS) and the secondary outcome measure was the Glasgow Outcome Scale. A total of 133 patients enrolled, with 9 (6.8%) dying, 41 (30.8%) remaining moderately disabled or worse (DRS scores 4–29), 83 (62.4%) remaining partially/mildly disabled or no disability (DRS scores 0–3). Logistic regression analysis revealed that age at injury (odds ratio (OR), 0.96; 95% confidence interval (CI), 0.92–0.99), length of intensive care unit stay (OR, 0.94; 95% CI, 0.88–0.99), and HBO₂ sessions (OR, 0.97; 95% CI, 0.95–0.99) were variables that independently influenced long-term prognosis. Cubic fitting models revealed that 14 and 21.6 sessions of HBO₂ could be effective for moderate and severe TBI, respectively. This study highlighted that HBO₂ in moderate-to-severe TBI may contribute to minimize death and reduce overall disability in the long-term. However, clinicians should be cautious of the potential risk of adverse long-term prognosis from excessive HBO₂ exposure when tailoring individualized HBO₂ regimens for patients with moderate-to-severe TBI. The study was registered on ClinicalTrials.gov (NCT05387018) on March 31, 2022.

摘要：高压氧在创伤性脑损伤领域的应用愈加广泛，但很少有关于其长期疗效的研究。此次试验评估高压氧治疗5-8年后中重度创伤性脑损伤患者的预后，以探索与预后相关的最佳高压氧方案。作者回顾性收集了2014年1月至2017年12月接受高压氧治疗的中重度创伤性脑损伤患者的临床数据，以残疾评定量表（DRS）和格拉斯哥预后评分为主要和次要观察指标。结果显示，在纳入133患者中9例（6.8%）死亡，41例（30.8%）存在中重度残疾（DRS评分4-29），83例（62.4%）存在轻度残疾或无残疾（DRS评分0-3）。逻辑回归分析显示，损伤年龄、ICU住院时间和高压氧疗程是影响中重度创伤性脑损伤患者长期预后的独立变量。3次拟合模型显示，14次和21.6次高压氧分别对中度和重度创伤性脑损伤有效。这项研究发现，高压氧在中重度创伤性脑损伤中可能有助于最大限度地减少死亡和减少整体残疾。然而，临床医生在为中重度创伤性脑损伤患者量身定制个性化的高压氧治疗方案时，应谨慎考虑过量暴露高压氧可能带来的长期不良预后风险。研究于2022年3月31日在ClinicalTrials.gov注册（NCT05387018）。