Prepared by: Evidence Synthesis Program (ESP) Coordinating Center
Portland VA Health Care System
Mark Helfand, MD, MPH, MS, Director
Recommended Citation: Parr NJ, Anderson J, Veazie S. Evidence Brief: Hyperbaric Oxygen Therapy for Traumatic Brain Injury and/or Post-traumatic Stress Disorder. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-199; 2021.
For patients hospitalized with acute moderate to severe TBI, available evidence suggests HBOT can reduce mortality and coma severity more than standard care, but it is unclear whether HBOT improves longer-term functionality. Evidence on HBOT for chronic mild TBI (mTBI) shows that HBOT does not lead to short-term improvements in post-concussion and PTSD symptoms compared to sham, and sparse longer-term evidence suggests symptom improvement after HBOT is not durable.
People with chronic mTBI and/or PTSD may not achieve symptom remission with currently recommended treatments. HBOT, which delivers 100% medical-grade oxygen inside a pressurized chamber, has been explored as a treatment alternative for those with persistent symptoms. The present review updates a 2018 review by the VA Evidence Synthesis Program (ESP) with new evidence on the use of HBOT in patients with mTBI and/or PTSD.
This updated synthesis included 6 trials in patients with mTBI and 7 trials in patients with acute moderate to severe TBI; 2 trials were completed since the earlier ESP review. In hospitalized patients with acute moderate to severe TBI, available evidence suggests HBOT can reduce mortality and coma severity, but effects on longer-term functionality and the optimal HBOT protocol for acute TBI are unclear. Evidence on HBOT for chronic mTBI shows that HBOT does not lead to short-term improvements in post-concussion and PTSD symptoms compared to sham, and sparse longer-term evidence suggests symptom improvement after HBOT is not durable. HBOT appears to be well-tolerated by patients with chronic mTBI, but severe pulmonary complications and seizures have occurred in patients with acute severe TBI. At present there is no evidence from clinical trials about patients diagnosed to have PTSD without a co-occurring TBI. Decisions about whether additional research is warranted must consider whether patient, provider, and system resources required for HBOT would be better directed toward other approaches. One future research direction could be to examine whether features of the HBOT treatment experience (eg, coordinated engagement with providers and other patients) are themselves active intervention components that could be incorporated into more widely implementable treatments for chronic post-concussion symptoms.