Neurological Sciences

, Volume 37, Issue 5, pp 693–701 | Cite as

Hyperbaric oxygen therapy for the treatment of traumatic brain injury: a meta-analysis

  • Fei Wang
  • Yong Wang
  • Tao Sun
  • Hua-lin YuEmail author
Original Article


Compelling evidence suggests the advantage of hyperbaric oxygen therapy (HBOT) in traumatic brain injury. The present meta-analysis evaluated the outcomes of HBOT in patients with traumatic brain injury (TBI). Prospective studies comparing hyperbaric oxygen therapy vs. control in patients with mild (GCS 13–15) to severe (GCS 3–8) TBI were hand-searched from medical databases using the terms “hyperbaric oxygen therapy, traumatic brain injury, and post-concussion syndrome”. Glasgow coma scale (GCS) was the primary outcome, while Glasgow outcome score (GOS), overall mortality, and changes in post-traumatic stress disorder (PTSD) score, constituted the secondary outcomes. The results of eight studies (average age of patients, 23–41 years) reveal a higher post-treatment GCS score in the HBOT group (pooled difference in means = 3.13, 95 % CI 2.34–3.92, P < 0.001), in addition to greater improvement in GOS and lower mortality, as compared to the control group. However, no significant change in the PTSD score was observed. Patients undergoing hyperbaric therapy achieved significant improvement in the GCS and GOS with a lower overall mortality, suggesting its utility as a standard intensive care regimen in traumatic brain injury.


Glasgow coma scale Glasgow outcome score Oxygen therapy Post-concussion syndrome Traumatic brain injury 



This study is founded by National Natural Science Foundation of China (No. 81260182); Natural Science Foundation of Yunnan Province (No. 2012FB036).

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest.


  1. 1.
    Xie Z, Zhuang M, Lin L, Xu H, Chen L, Hu L (2007) Changes of plasma C-reactive protein in patients with craniocerebral injury before and after hyperbaric oxygenation: a randomly controlled study. NRR 2(5):314–317Google Scholar
  2. 2.
    Hills BA (1999) A role for oxygen-induced osmosis in hyperbaric oxygen therapy. Med Hypotheses 52(3):259–263CrossRefPubMedGoogle Scholar
  3. 3.
    Neubauer RA, James P (1998) Cerebral oxygenation and the recoverable brain. Neurol Res 20(Suppl 1):S33–S36PubMedGoogle Scholar
  4. 4.
    Bennett MH, Trytko B, Jonker B (2004) Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. Cochrane Database Syst Rev (4):CD004609Google Scholar
  5. 5.
    Bennett MH, Trytko B, Jonker B (2012) Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. Cochrane Database Syst Rev 12:CD004609Google Scholar
  6. 6.
    Rockswold SB, Rockswold GL, Vargo JM, Erickson CA, Sutton RL, Bergman TA, Biros MH (2001) Effects of hyperbaric oxygenation therapy on cerebral metabolism and intracranial pressure in severely brain injured patients. J Neurosurg 94(3):403–411CrossRefPubMedGoogle Scholar
  7. 7.
    Golden ZL, Neubauer R, Golden CJ, Greene L, Marsh J, Mleko A (2002) Improvement in cerebral metabolism in chronic brain injury after hyperbaric oxygen therapy. Int J Neurosci 112(2):119–131CrossRefPubMedGoogle Scholar
  8. 8.
    Boussi-Gross R, Golan H, Fishlev G, Bechor Y, Volkov O, Bergan J, Friedman M, Hoofien D, Shlamkovitch N, Ben-Jacob E, Efrati S (2013) Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury-randomized prospective trial. PLoS One 8(11):e79995CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Huang L, Obenaus A (2011) Hyperbaric oxygen therapy for traumatic brain injury. Med Gas Res 1(1):21CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wolf G, Cifu D, Baugh L, Carne W, Profenna L (2012) The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury. J Neurotrauma 29(17):2606–2612CrossRefPubMedGoogle Scholar
  11. 11.
    Cifu DX, Hart BB, West SL, Walker W, Carne W (2014) The effect of hyperbaric oxygen on persistent postconcussion symptoms. J Head Trauma Rehabil 29(1):11–20CrossRefPubMedGoogle Scholar
  12. 12.
    Walker WC, Franke LM, Cifu DX, Hart BB (2013) Randomized, sham-controlled, feasibility trial of hyperbaric oxygen for service members with postconcussion syndrome: cognitive and psychomotor outcomes 1 week postintervention. Neurorehab Neural Re 28(5):420–432CrossRefGoogle Scholar
  13. 13.
    Harch PG, Andrews SR, Fogarty EF, Amen D, Pezzullo JC, Lucarini J, Aubrey C, Taylor DV, Staab PK, Van Meter KW (2012) A phase I study of low-pressure hyperbaric oxygen therapy for blast-induced post-concussion syndrome and post-traumatic stress disorder. J Neurotrauma 29(1):168–185CrossRefPubMedGoogle Scholar
  14. 14.
    Rockswold SB, Rockswold GL, Zaun DA, Zhang X, Cerra CE, Bergman TA, Liu J (2010) A prospective, randomized clinical trial to compare the effect of hyperbaric to normobaric hyperoxia on cerebral metabolism, intracranial pressure, and oxygen toxicity in severe traumatic brain injury. J Neurosurg 112(5):1080–1094CrossRefPubMedGoogle Scholar
  15. 15.
    Murray GD, Teasdale GM, Braakman R, Cohadon F, Dearden M, Iannotti F, Karimi A, Lapierre F, Maas A, Ohman J, Persson L, Servadei F, Stocchetti N, Trojanowski T, Unterberg A (1999) The European Brain Injury Consortium survey of head injuries. Acta Neurochir 141(3):223–236CrossRefPubMedGoogle Scholar
  16. 16.
    Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE (1999) Traumatic brain injury in the USA: A public health perspective. J Head Trauma Rehabil 14(6):602–615CrossRefPubMedGoogle Scholar
  17. 17.
    Higgins JPL, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group; Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR (2000) Empirical assessment of effect of publication bias on meta-analyses. BMJ 320(7249):1574–1577 (PubMed PMID: 10845965) CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Rockswold SB, Rockswold GL, Zaun DA, Liu J (2013) A prospective, randomized Phase II clinical trial to evaluate the effect of combined hyperbaric and normobaric hyperoxia on cerebral metabolism, intracranial pressure, oxygen toxicity, and clinical outcome in severe traumatic brain injury. J Neurosurg 118(6):1317–1328CrossRefPubMedGoogle Scholar
  20. 20.
    Lin JW, Tsai JT, Lee LM, Lin CM, Hung CC, Hung KS, Chen WY, Wei L, Ko CP, Su YK, Chiu WT (2008) Effect of hyperbaric oxygen on patients with traumatic brain injury. Acta neurochirgica Supplement 101:145–149CrossRefGoogle Scholar
  21. 21.
    Ren H, Wang W, Ge Z (2001) Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury. Chin J Traumatol 4(4):239–241PubMedGoogle Scholar
  22. 22.
    Rockswold GL, Ford SE, Anderson DC, Bergman TA, Sherman RE (1992) Results of a prospective randomized trial for treatment of severely brain-injured patients with hyperbaric oxygen. J Neurosurg 76(6):929–934CrossRefPubMedGoogle Scholar
  23. 23.
    Mao J-H, Sun Z-S, Xiang Y (2010) Observation of curative effects of hyperbaric oxygen for treatment on severe craniocerebral injury. J Clin Neurol 23(5):386–388Google Scholar
  24. 24.
    Davis MC, Shoja MM, Tubbs SR, Griessenauer CJ (2014) Hyperbaric oxygen therapy for chronic post-concussive syndrome. Med Gas Res 4(1):8CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kumaria A, Tolias CM (2009) Normobaric hyperoxia therapy for traumatic brain injury and stroke: a review. British J Neurosurg 23(6):576–584CrossRefGoogle Scholar
  26. 26.
    Narotam PK, Morrison JF, Nathoo N (2009) Brain tissue oxygen monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen-directed therapy. J Neurosurg 111(4):672–682CrossRefPubMedGoogle Scholar
  27. 27.
    Miller RS, Weaver LK, Bahraini N, Churchill S, Price RC, Skiba V, Caviness J, Mooney S, Hetzell B, Liu J, Deru K, Ricciardi R, Fracisco S, Close NC, Surrett GW, Bartos C, Ryan M, Brenner LA (2015) HOPPS Trial Team. Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial. JAMA. Intern Med 175(1):43–52Google Scholar

Copyright information

© Springer-Verlag Italia 2016

Authors and Affiliations

  1. 1.The Second Department of NeurosurgeryFirst Affiliated Hospital of Kunming Medical UniversityKunmingChina

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