Hyperbaric Oxygen Therapy Sessions Research Articles

The effectiveness of hyperbaric oxygen therapy for managing radiation-induced proctitis - results of a 10-year retrospective cohort study.

Despite modern radiotherapy (RT) techniques, radiation-induced proctitis (RIP) remains a significant complication of RT for pelvic organ malignancies. Over the last decades, an enormous therapeutic armamentarium has been considered in RIP, including hyperbaric oxygen therapy (HBOT). However, the evidence regarding the impact of HBOT on RIP is conflicting. This study aims to evaluate the effectiveness and safety of HBOT in the treatment of RIP. Ten-year (2013-2023) retrospective analysis of all consecutive patients with RIP treated with HBOT at Centro de Medicina Subaquática e Hiperbárica (CMSH) (Armed Forces Hospital - Lisbon, Portugal). Patients were exposed to 100% oxygen at 2.5 ATA, in a multiplace first-class hyperbaric chamber, for 70-min periods, once daily, five times per week. Fisher's exact test was performed using SPSS (version 23.0); p<0.05 was accepted as statistically significant. Of a total of 151 patients with RIP, 88 were included in the final analysis, of whom 38.6% evidenced other concurrent radiation-induced soft tissue lesions. The most reported primary pelvic tumor treated with RT was prostate cancer (77.3%), followed by cervical cancer (10.2%). Hematochezia was the most observed clinical manifestation (86.4%). After a median of 60 HBOT sessions (interquartile range [IQR]: 40-87.5), 62.5% and 31.8% of patients achieved a clinical complete and partial response, respectively, with a hematochezia resolution rate of 93.7% (complete or partial). While partial and complete responses require fewer than 70 sessions of HBOT in terms of overall RIP symptoms (p=0.069), isolated hematochezia tends to require at least 70 sessions (p=0.075). Individuals with at least two concurrent late radiation tissue injuries were associated with a complete response to HBOT (p=0.029). Only about 5.7% of patients did not respond to the treatment. Eighteen patients (20.5%) developed reversible ear barotrauma. The number of HBOT sessions was a predictor of HBOT side effects (odds ratio: 1.010; 95% confidence interval, 1.000-1.020; p=0.047). The HBOT proved to be an effective and safe treatment for RIP refractory to medical and/or endoscopic treatments. This real-world evidence study adds value to published data on the management of RIP with HBOT.

The effect of hyperbaric oxygen therapy on corneal endothelial structure and anterior segment parameters

Purpose To assess the effect of hyperbaric oxygen therapy (HBOT) on corneal endothelial structure and anterior segment parameters in healthy eyes. Methods 17 eyes of 17 patients who were scheduled to receive HBOT for other than ophthalmologic indications were investigated in this prospective study. Central corneal thickness (CCT) and corneal endothelial properties were evaluated using a specular microscope. Endothelial cell density (ECD), average cell area (AVG), coefficient of variation in cell size (CV), percentage of hexagonal cells (HEX), CCT, intraocular pressure (IOP), spherical equivalent (SE), axial length (AL) and anterior chamber depth (ACD) values were measured before the HBOT, after the 1st session, and after the 20th session of therapy. Results 47% of the patients (n = 8) received HBOT because of avascular necrosis, 35% (n = 6) due to sudden hearing loss, 12% (n = 2) for diabetic foot, and 6% (n = 1) for wound infection. The mean IOP was 14,80 mmHg before HBOT, 14,20 mmHg after the 1st session, and 13,73 mmHg after the 20th session. The mean ACD was 3,38 mm before HBOT, 3,34 mm after the 1st session, and 3,16 mm after the 20th session. Although the mean IOP and ACD decreased after HBOT sessions, it was not statistically significant (p > 0.05). A significant reduction was observed in SE values after 20 sessions of HBOT compared to the values measured before HBOT (p = 0,009). The mean ECD was 2572,53 ± 261,51 cells/mm2 before HBOT, 2554,47 ± 236,13 after the 1st session, and 2563,13 ± 226,92 after the 20th session. When the corneal properties measured before and after HBOT sessions were compared, no significant difference was found in terms of CCT, ECD, AVG, CV, and HEX (p > 0.05). Conclusion We observed no significant change in CCT, corneal endothelial layer properties, and anterior segment morphology after the 1st session, and after the 20th session of HBOT. Although HBOT reduced IOP and ACD, it was not statistically significant. HBOT may lead to a significant decrease in SE values after the 20th session.

Hyperbaric oxygenation improve red blood cell deformability in patients with acute or chronic inflammation.

Red blood cells (RBC) are one of the key elements of the microcirculation. Their ability to pass through capillaries and to deliver oxygen to cells is due to their large degree of deformability linked to the characteristics of the RBC membrane. Alterations in RBC deformability as a result of membrane damage, linked in part to increased synthesis of reactive oxygen species (ROS), can be observed in several diseases, such as sepsis, and may contribute to the altered microcirculation observed in these pathologies. Hyperbaric oxygen therapy (HBOT), with inhalation of 100% oxygen, has been proposed in several acute or chronic pathologies, including carbon monoxide poisoning. We investigated the effects of HBOT on oxidative stress from ROS produced by myeloperoxidase (MPO) and on RBC deformability in patients with acute or chronic inflammation (n=10), in patients with acute carbon monoxide poisoning (n=10), and in healthy volunteers (n=10). RBC deformability was evaluated before and after HBOT in the various populations using the ektacytometry technique (Laser-assisted Optical Rotational Red Cell Analyzer - LORRCA). Deformability was determined by the elongation index (EI) in relation to the shear stress (SS) over a range of 0.3 to 50Pa. Oxidative stress was estimated through changes in proteins (chlorotyrosine and homocitrulline) induced by MPO activity measured by liquid chromatography-tandem mass spectrometry analysis. Before HBOT, EI was significantly lower in patients with acute or chronic inflammation than in healthy volunteers and patients with acute carbon monoxide poisoning for the majority of SS values studied. After one session of HBOT, the EI was significantly higher than before HBOT for SS values of 1.93Pa or higher in patients with acute or chronic inflammation. This effect remains constant after 10 sessions. There were no differences before and after HBOT in protein or amino acid oxidation due to ROS generation mediated by MPO in the three populations. Our results confirm altered RBC deformability in patients with acute and chronic conditions associated with an underlying inflammatory process. HBOT improves deformability only after one session and therefore may improve microcirculation in this population. According to our results, this improvement does not seem mediated by the ROS pathway via MPO. These results need to be confirmed in a larger population.

Therapeutic Impacts of Hyperbaric Oxygen Therapy and Risperidone on Children with Autism: A Clinical Trial.

In this research, we investigated any possible effect of receiving hyperbaric oxygen therapy (HBOT) or risperidone on the core symptoms of autism in children diagnosed with autism spectrum disorder (ASD). This study was a randomized, controlled clinical trial in Minia and Assiut University hospitals in Egypt with three parallel groups. One hundred and eighty children with autism, aged 5-8 years were divided into three equal groups (n=60). Group 1 (G1) received 40 sessions of HBOT within two months, group 2 (G2) received risperidone (dose: 0.25 mg per day in children weighing less than 20 kg and 0.5 mg per day in cases weighing more) for six months, and group 3 (G3) as the control group, received a placebo for six months. The assessment was done using childhood autism rating scale (CARS) and autism treatment evaluation checklist (ATEC) at the beginning of the study (baseline) and after one year. The mean total CARS and ATEC scores significantly decreased (improved) by varying degrees in the three groups after a year of follow-up compared to the baseline scores, but the best results were found in G1, G2, and G3, respectively. Using HBOT or risperidone is effective in treating the core symptoms of autism in children diagnosed with autism spectrum disorder, but using HBOT gives better results than risperidone therapy. Non-pharmacologic therapy can be used for the treatment of the core symptoms of autism.Both hyperbaric oxygen therapy and risperidone reduce the core symptoms of autism.Hyperbaric oxygen therapy gives better effects than risperidone in reducing the core symptoms of autism. Since the long-term use of drug therapy in children with autism leads to the occurrence of side effects in addition to the difficulty in complying with the drugs for long-term use, efforts have begun to use non-traditional alternative treatments, such as hyperbaric oxygen therapy. The current study assessed the therapeutic effect of hyperbaric oxygen therapy and risperidone on the core symptoms of autism. The results revealed that both hyperbaric oxygen therapy and risperidone reduced the core symptoms of autism, but hyperbaric oxygen therapy gave better therapeutic results than risperidone.

The effect of hyperbaric oxygen therapy on myocardial function in post- covid syndrome patients: a randomized controlled trial

Abstract Funding Acknowledgements Type of funding sources: None. Background Post-COVID-19 condition refers to a range of persisting physical and neurocognitive symptoms following SARS-CoV-2 infection. Recent evidence revealed that post-COVID syndrome patients may suffer from cardiac dysfunction and are at increased risk for a broad range of cardiovascular disorders. This randomized, sham-control, double-blind trial evaluated the effect of hyperbaric oxygen therapy (HBOT) on the cardiac function of post-COVID-19 patients with ongoing symptoms for at least three months after confirmed infection. Methods Sixty patients were randomized to receive 40 daily HBOT or sham sessions. They underwent echocardiography at baseline and 1-3 weeks after the last protocol session. Results Twenty-nine (48.3%) patients had reduced global longitudinal strain (GLS) at baseline. Of them, 13 (43.3%) and 16 (53.3%) were allocated to the sham and HBOT groups, respectively. Compared to the sham group, GLS significantly increased following HBOT (−17.8±1.1 to −20.2±1.0, p = 0.0001), with a significant group-by-time interaction (p = 0.041). Conclusion Post-COVID syndrome patients despite normal EF often have subclinical left ventricular dysfunction that is characterized by mildly reduced GLS. HBOT promotes left ventricular systolic function recovery in patients suffering from post COVID-19 condition. Further studies are needed to optimize patient selection and evaluate long-term outcomes.

The effect of hyperbaric oxygen therapy on myocardial function in post-COVID-19 syndrome patients: a randomized controlled trial

Post-COVID-19 condition refers to a range of persisting physical, neurocognitive, and neuropsychological symptoms following SARS-CoV-2 infection. Recent evidence revealed that post-COVID-19 syndrome patients may suffer from cardiac dysfunction and are at increased risk for a broad range of cardiovascular disorders. This randomized, sham-control, double-blind trial evaluated the effect of hyperbaric oxygen therapy (HBOT) on the cardiac function of post-COVID-19 patients with ongoing symptoms for at least three months after confirmed infection. Sixty patients were randomized to receive 40 daily HBOT or sham sessions. They underwent echocardiography at baseline and 1–3 weeks after the last protocol session. Twenty-nine (48.3%) patients had reduced global longitudinal strain (GLS) at baseline. Of them, 13 (43.3%) and 16 (53.3%) were allocated to the sham and HBOT groups, respectively. Compared to the sham group, GLS significantly increased following HBOT (− 17.8 ± 1.1 to − 20.2 ± 1.0, p = 0.0001), with a significant group-by-time interaction (p = 0.041). In conclusion, post-COVID-19 syndrome patients despite normal EF often have subclinical left ventricular dysfunction that is characterized by mildly reduced GLS. HBOT promotes left ventricular systolic function recovery in patients suffering from post COVID-19 condition. Further studies are needed to optimize patient selection and evaluate long-term outcomes.This study was registered with ClinicalTrials.gov, number NCT04647656 on 01/12/2020.

Hyperbaric oxygen therapy does not change the amputation level in patients with fasciotomy after an earthquake: Our single-center experience after 2023 Kahramanmaras earthquake.

This study aims to evaluate the effect of hyperbaric oxygen therapy (HBOT) on the amputation level in patients undergoing fasciotomy with a Mangled Extremity Severity Score (MESS) score of ≥7 after 2023 Kahramanmaras earthquake. Between February 6th, 2023 and March 10th, 2023, a total of 23 patients (14 males, 9 females; mean age: 36.8±13.2 years; range, 17 to 64 years) who needed amputation with a MESS score of ≥7 and refused amputation were included in the study. All fasciotomies were performed in an external center, and five of them was incomplete. First, incomplete fasciotomies were completed with debridement due to deep muscle necrosis. Daily two HBOT sessions were performed for the first three days. In the following days, daily one HBOT session was performed. The HBOT was terminated for the patients who were decided by the council that they did not benefit from HBOT treatment. Six (26.08%) of the patients had a bone fracture (n=2 forearm, n=1 femur, n=2 tibia, and n=1 ankle fracture). The mean number of HBOT session was 13.24±5.4 (range, 7 to 30) and the mean duration of HBOT was 26.5±10.8 (range, 14 to 60) h. The mean MESS score was 9.96±1.36 (range, 7 to 12). All of the patients were trapped under the rubble with a mean time of 12.3±5.4 (range, 6 to 23) h. All fasciotomies were performed within the first 30 h. Twenty-two of the patients were amputated at the level previously determined by the experienced trauma surgeons. The amputation level changed in only one patient. After 38 h of HBOT, transradial amputation was performed to the patient in whom transhumeral amputation level was determined previously. None of the patients had any adverse event related to HBOT. Our study results suggest that the MESS is a useful scoring system for amputation decision after a high-energy trauma, such as an earthquake, with a high accuracy rate. The outcomes of HBOT are not satisfactory for high-energy traumas, such as earthquakes, in those requiring fasciotomy having more muscle necrosis and a MESS score of ≥7.

Hyperbaric Oxygen Therapy for the Management of Mild and Moderate Traumatic Brain Injury: A Single-Center Experience

Hyperbaric oxygen therapy (HBOT) has been shown to be an effective modality in the management of a variety of conditions. However, its role in the treatment of traumatic brain injury (TBI) remains an area of controversy. This study aims to evaluate the safety and outcomes of HBOT in managing the long-term sequelae of TBI. The records of TBI patients who underwent increments of 40 sessions of HBOT at 1.5 atmosphere absolute at a single medical center were reviewed. The outcome measures included physical, cognitive (i.e., Trail Making Test, parts A and B; U.S. Department of Veterans Affairs' Evaluation of Cognitive Impairment and Subjective Symptoms tool), and single-photon emission computed tomography findings. The complications and withdrawals were recorded. During the study period, 17 patients underwent HBOT to manage the long-term sequelae of their TBI. Of the 17 patients, 12 (70.6%) completed 120 HBOT sessions and were evaluated 3 months after treatment. All 12 patients had statistically significant improvements in their Trail Making Test, parts A and B, and U.S. Department of Veterans Affairs' Evaluation of Cognitive Impairment and Subjective Symptoms scores (P < 0.05). Additionally, single-photon emission computed tomography depicted increased cerebral blood flow and oxygen metabolism among studied subjects compared with the baseline values. A total of 5 patients withdrew from the study, which was related to new-onset headaches associated with HBOT for 1 patient. HBOT using 1.5 atmosphere absolute in increments of 40 sessions was found to be a safe and effective modality in the management of the long-term sequelae of TBI. HBOT should be considered in the management of this patient population.

DIONYSIUS trial: “Does increasing oxygen nurture your symptomatic ischaemic ulcer sufficiently?” Study protocol for an international multicentre randomised trial

IntroductionDiabetic foot ulcers (DFUs) are a major complication of diabetes and often associated with peripheral arterial occlusive disease. Current available evidence shows hyperbaric oxygen therapy (HBOT) can reduce the risk...

Hyperbaric Oxygen Therapy Reduces Oxidative Stress and Inflammation, and Increases Growth Factors Favouring the Healing Process of Diabetic Wounds.

Hyperbaric oxygen therapy (HBOT) is the clinical application of oxygen at pressures higher than atmospheric pressure. HBOT has been effectively used to manage diverse clinical pathologies, such as non-healing diabetic ulcers. The aim of the present study was to analyse the effects of HBOT on the plasma oxidative and inflammation biomarkers and growth factors in patients with chronic diabetic wounds. The participants received 20 HBOT sessions (five sessions/week), and blood samples were obtained at sessions 1, 5 and 20, before and 2 h after the HBOT. An additional (control) blood sample was collected 28 days after wound recovery. No significant differences were evident in haematological parameters, whereas the biochemical parameters progressively decreased, which was significant for creatine phosphokinase (CPK) and aspartate aminotransferase (AST). The pro-inflammatory mediators, tumour necrosis factor alpha (TNF-α) and interleukin 1β (IL-1β), progressively decreased throughout the treatments. Biomarkers of oxidative stress--plasma protein levels of catalase, extracellular superoxide dismutase, myeloperoxidase, xanthine oxidase, malondialdehyde (MDA) levels and protein carbonyls--were reduced in accordance with wound healing. Plasma levels of growth factors--platelet-derived growth factor (PDFG), transforming growth factor β (TGF-β) and hypoxia-inducible factor 1-alpha (HIF-1α)-- were increased as a consequence of HBOT and reduced 28 days after complete wound healing, whereas matrix metallopeptidase 9 (MMP9) progressively decreased with the HBOT. In conclusion, HBOT reduced oxidative and pro-inflammatory mediators, and may participate in activating healing, angiogenesis and vascular tone regulation by increasing the release of growth factors.

Multiple branch retinal artery occlusions following the new facial cosmetic filler (Poly-D, L-lactic Acid) injection a case report

BackgroundPoly-D, L-lactic acid is (PDLLA) a new cosmetic filler. We reported the first case of PDLLA-related devastating complication of multiple branch retinal artery occlusion (BRAO).Case presentationA 23-year-old female had sudden blindness after injection of PDLLA at the glabella. After emergency intraocular pressure-lowering medicine, ocular massage, steroid pulse therapy, heparin and alprostadil infusion, and subsequent treatments including acupuncture and 40 sessions of hyperbaric oxygen therapy, her best-corrected visual acuity improved from hand motion at 30 cm to 0.3 within 2 months.ConclusionAlthough safety of PDLLA was evaluated in animal studies and in 16,000 human cases, it could still cause rare but devastating retinal artery occlusion as in the present case. Proper and immediate therapies could still improve patient’s vision and scotoma. Surgeons should keep in mind the possibility of iatrogenic filler-related retinal artery occlusion.

Association between number of hyperbaric oxygen therapy sessions and neurocognitive outcomes of acute carbon monoxide poisoning.

Hyperbaric oxygen therapy (HBO2) is recommended for symptomatic patients within 24 h of carbon monoxide (CO) poisoning. Currently, there is no consensus on the number of HBO2 sessions within 24 h after arrival at the hospital. Therefore, we evaluated differences in the therapeutic effects according to the number of HBO2 sessions in acute CO poisoning. This cohort study included data collected from our CO poisoning registry and prospective cohorts between January 2006 and August 2021 in a single academic medical center in South Korea. Based on the number of HBO2 sessions performed within 24 h, we classified patients into one- and multiple- (two or three) session groups. We also compared mild (non-invasive mechanical ventilation) and severe (invasive mechanical ventilation) groups. CO-related neurocognitive outcomes were measured using the Global Deterioration Scale (GDS; stages: 1-7) combined with neurological impairment at 1 month after poisoning. We classified GDS stages as favorable (1-3 stages) and poor (4-7 stages) neurocognitive outcomes. Patients belonging to a favorable group based on GDS assessment, but with observable neurological impairment, were assigned to the poor outcome group. Propensity score matching (PSM) was performed to adjust for age, sex, and related variables to identify statistical differences between groups. We analyzed the data of 537 patients between ages 16 and 70 years treated with HBO2. After PSM, there was no significant difference in neurocognitive outcomes at 1 month among the two groups of patients (p = 0.869). Furthermore, there were no significant differences in neurocognitive outcomes between invasive mechanical ventilation and non-invasive mechanical ventilation patients in the three groups (p = 0.389 and p = 0.295). There were no significant differences in the reduction of poor neurocognitive outcomes according to the number of HBO2 sessions implemented within 24 h of CO exposure.

Assessing the Efficacy of Hyperbaric Oxygen Therapy on Facelift Outcomes: A Case-Control Study Comparing Outcomes in Patients With and Without Hyperbaric Oxygen Therapy.

Wound healing remains among the most concerning complications in aesthetic surgery. The use of hyperbaric oxygen therapy (HBOT) is an accepted method of supporting wound healing. The aim of this study is to assess the role of HBOT in postoperative healing and complication rates following facelift surgery. This case-control study comprised facelift patients who received HBOT and those who did not between 2019 and 2022. Data were extracted from the patients' medical records, with the primary outcomes being the presence of complications, wound-healing duration, and patient satisfaction. The authors recruited 20 female patients who underwent facelift for this study, with 9 patients in the HBOT group and 11 patients in the control group. The average number of HBOT sessions received was 7.22, and each session lasted an average of 78 ± 5 min. The duration of wound healing in the HBOT group ranged from 7 to 30 days (mean of 13.3 days), whereas the control group ranged from 6 to 90 days (mean of 36.9 days). This indicates a statistically significant shorter time to wound healing in the HBOT group compared to the control group (P < .001). Future prospective randomized controlled trials with larger sample sizes and blinding are needed to further evaluate the potential benefits of HBOT in the postoperative period. Nonetheless, our findings suggest that HBOT may be a promising adjunctive therapy for patients undergoing facelift surgery.

Barodontalgia during hyperbaric oxygen therapy of an 8-year-old male: a case report

Barodontalgia, barometric pressure-induced dental pain, may occur during hyperbaric oxygen therapy due to pressure changes. This case report represents an 8-year-old male patient with barodontalgia. The patient declared a severe toothache during hyperbaric therapy. The diving medicine specialist referred the patient to the dental clinician immediately. Upon clinical examination, the pain was thought to be caused by caries lesions of the deciduous teeth in the left maxillary molar region. Tooth extraction was suggested. After extraction, patient continued hyperbaric oxygen therapy sessions without any pain. Patient was recommended for a session to intraoral and radiographic examination one week after the extraction. In conclusion, caries lesions and faulty restorations should be examined before hyperbaric oxygen therapy sessions. Even though barodontalgia is a rare phenomenon, dental examination is essential to avoid these kinds of pain-related complications. All carious lesions and defective restorations must be treated, if necessary. Removal of faulty restorations, and management of inflammation as part of the treatment is suggested before being exposed to pressure changes.

The effectiveness of the inclusion of hyperbaric oxygenation in the complex therapy of patients with COVID-19: retrospective study

The effectiveness of the inclusion of hyperbaric oxygenation in the complex therapy of patients with COVID-19: retrospective study

Addition of hyperbaric oxygen therapy versus usual care alone for inflammatory bowel disease: A systematic review and meta-analysis

ObjectiveInflammatory bowel disease (IBD) is a chronic idiopathic inflammatory disease that includes ulcerative colitis (UC) and Crohn's disease (CD). Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a pressurized environment. Existing literature suggests that HBOT may be an effective therapy for IBD, but a quantitative analysis is lacking. This study aims to estimate the adjunctive role of HBOT in treating IBD and lowering its recurrence rate. DesignSystematic review and meta-analysis. MethodsThe Cochrane Library, EMBASE, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang databases were systematically searched by two reviewers independently. Meta-analyses were performed using Review Manager (RevMan, version 5.3). A random-effects model was applied due to the heterogeneity between studies. ResultsTwenty-nine out of the initially identified 606 articles were covered in this review, with a total of 2151 patients (2071 for UC and 80 for CD). No randomized data of HBOT for CD were included. Among UC patients, usual care plus HBOT were more likely to achieve a clinical response than usual care alone (risk ratio [RR], 1.24; 95% confidence interval (CI), 1.17 to 1.31; P < 0.001). Subgroup analysis showed that the number of HBOT sessions had no statistically significant effect on overall efficacy (P > 0.05). The pooled data showed a lower recurrence rate in the usual care plus HBOT group (RR, 0.35; 95% CI, 0.24 to 0.53; P < 0.001). The standardized mean difference in the serum tumor necrosis factor level between HBOT and non-HBOT groups was -2.13 (95% CI, -3.09 to -1.18; P < 0.001). No severe adverse events of HBOT were observed. ConclusionsHBOT might be an effective and safe adjunctive treatment for IBD. Further studies are required to investigate the optimal protocol of HBOT in IBD treatment.

Hyperbaric oxygen therapy in children with post-concussion syndrome improves cognitive and behavioral function: a randomized controlled trial

Persistent post-concussion syndrome (PPCS) is a common and significant morbidity among children following traumatic brain injury (TBI) and the evidence for effective PPCS treatments remains limited. Recent studies have shown the beneficial effects of hyperbaric oxygen therapy (HBOT) in PPCS adult patients. This randomized, sham-control, double blind trial evaluated the effect of hyperbaric oxygen therapy (HBOT) on children (age 8–15) suffering from PPCS from mild-moderate TBI events six months to 10 years prior. Twenty-five children were randomized to receive 60 daily sessions of HBOT (n = 15) or sham (n = 10) treatments. Following HBOT, there was a significant increase in cognitive function including the general cognitive score (d = 0.598, p = 0.01), memory (d = 0.480, p = 0.02), executive function (d = 0.739, p = 0.003), PPCS symptoms including emotional score (p = 0.04, d = – 0.676), behavioral symptoms including hyperactivity (d = 0.244, p = 0.03), global executive composite score (d = 0.528, p = 0.001), planning/organizing score (d = 1.09, p = 0.007). Clinical outcomes correlated with significant improvements in brain MRI microstructural changes in the insula, supramarginal, lingual, inferior frontal and fusiform gyri. The study suggests that HBOT improves both cognitive and behavioral function, PPCS symptoms, and quality of life in pediatric PPCS patients at the chronic stage, even years after injury. Additional data is needed to optimize the protocol and to characterize the children who can benefit the most.

The effectiveness of hyperbaric oxygen therapy on the final outcome of patients with sudden sensorineural hearing loss

PurposeTo evaluate the therapeutic effect of the combination of systemic steroids (SS) and hyperbaric oxygen therapy (HBOT) in patients with idiopathic sudden sensorineural hearing loss (SSNHL). Materials and methodsFifty patients with idiopathic sudden sensorineural hearing loss were allocated into 2 groups: the control group received Dexamethasone IV (SS) and the therapy group received Dexamethasone IV combined with 15 sessions of hyperbaric oxygen therapy (SS + HBOT) as initial treatment. Hearing assessment was performed at the admission to hospital and 3 months after the onset of treatment. Siegel's criteria were used to evaluate the hearing outcomes. Prognostic factors were identified by linear regression analyses. ResultsHearing improvement rate was 64 % in the therapy group and 56 % in the control group, difference which was not statistically significant (p = 0.369). Furthermore, when patients of each group were categorized into 5 subgroups by disease severity (mild, moderate, moderate to severe, severe, profound), differences in treatment outcome between the subgroups of the same severity were not significant. A descending type audiogram curve was proven an unfavorable prognostic factor in both groups, as it led to a significantly lower hearing gain (30 dB) compared to other curve shapes (b = −29.10, 95 % CI = −56.39, −1.82). ConclusionsThe addition of hyperbaric oxygen therapy to systemic steroids caused no significant hearing improvement, despite a mild tendency toward a greater improvement rate within the combination group. More prospective randomized trials with larger series of patients could shed even more light on the effectiveness of combination therapy (SS + HBOT) in patients affected by SSNHL.

Therapeutic study of hyperbaric oxygen on heme oxygenase-1 (HO-1) in patients with acute carbon monoxide poisoning and myocardial injury.

Carbon monoxide (CO) poisoning causes myocardial injury, which is attenuated by hyperbaric oxygen therapy (HBOT). During CO poisoning, the body increases anti-inflammatory proteins, including heme oxygenase-1 (HO-1), in response to oxidative stress. Considering the myocardial injury resulting from CO poisoning and the lack of sufficient information about the effect of HBOT on HO-1, the present study evaluated the effect of hyperbaric oxygen therapy on heme oxygenase-1 (HO-1) in patients with acute carbon monoxide poisoning and myocardial injury. In this regard, in a before-after Quasi-Experimental study, 20 patients with carbon monoxide poisoning and myocardial injury were studied. All patients underwent 40 daily hyperbaric oxygen therapy sessions for 90 minutes at a pressure of 2.4 ATA. Also, 20 healthy individuals, as a control group, were participated. To evaluate and compare the mRNA level of the HO-1 gene, the Real-time PCR technique was used. Paired t-test was used to compare the two indices of 6min walking distance and pulmonary arterial pressure (PAP) before and after the intervention. The results showed that the difference during 12 weeks was 8.65 ± 4.91 for PAP, and this reduction in pressure was statistically significant (P = 0.0092). The distance traveled increased by 28 ± 10.88 m in 6 minutes at the end of the study (P = 0.0084). Regarding the expression level of HO-1, the results showed that the expression level in the intervention group before the test had a significant increase compared to the control group (p = 0.0004). However, after hyperbaric oxygen therapy, the expression of this gene decreased significantly, and there was no statistically significant difference with the control group (p = 0.062). Overall, the results showed that HBOT significantly decreased HO-1 gene expression in CO poisoning and myocardial injury patients. It indicates the importance of HBOT in the treatment and compensation of cardiac tissue damage caused by CO poisoning.

The effect of hyperbaric oxygen therapy on central macular thickness and choroidal thickness in the healthy eyes of patients with idiopathic sudden sensorineural hearing loss

Purpose To evaluate the effect of hyperbaric oxygen therapy (HBOT) for idiopathic sudden sensorineural hearing loss (ISSNHL) on central macular thickness (CMT) and choroidal thickness (CT). Materials and Methods The study included 42 healthy eyes of 21 patients with ISSNHL (aged 24–61 years) who started HBOT within the first three days of the onset of hearing loss. Duration and severity of hearing loss were noted before starting HBOT. Central macular thickness (CMT), choroidal thickness (CT) 1500 µm nasal and temporal of the fovea, and subfoveal CT were measured by spectral domain optic coherence tomography before the first session of HBOT and after sessions 10 and 20. Measurements obtained before and after HBOT were compared. Results Eleven patients (52.4%) were men and 10 (47.6%) were women. The mean age was 44.67 ± 10.1 years. The mean duration of sudden hearing loss before HBOT was 2.05 ± 1 day. Hearing loss was mild in five patients, moderate in five patients, moderate to severe in 2 patients, severe in 4 patients and profound in 5 patients. Comparison of measurements obtained before HBOT and after 10 and 20 sessions of HBOT revealed no significant differences in CMT (219.17 ± 22.91, 220.33 ± 19.66, and 220.21 ± 19.3 µm), subfoveal CT (347.71 ± 66.82, 348.38 ± 74.55, and 345.45 ± 75.39 µm), nasal CT (328.64 ± 82.31, 316.02 ± 79.32, and 313.52 ± 89.92 µm), or temporal CT (321.76 ± 71.29, 317.05 ± 73.94, and 314.05 ± 74.61 µm, respectively) (p > 0.05). Conclusions HBOT for the treatment of ISSNHL had no significant effect on CMT or CT in healthy eyes.