Hyperbaric oxygen for mTBI-associated PCS and PTSD: Pooled analysis of results from Department of Defense and other published studies.

Abstract

BACKGROUND:

Some clinical trials report improvement in persistent post-concussive symptoms (PCS) with hyperbaric oxygen (HBO2) following mild traumatic brain injury (mTBI), but questions remain regarding the utility of HBO2 for PCS, the effects of HBO2 on post-traumatic stress disorder (PTSD), and the influences of sham control exposures.

METHODS:

A systematic review and pooled analysis was conducted to summarize available evidence for HBO2 in mTBI-associated PCS ± PTSD. Data aggregated from four Department of Defense (DoD) studies with participant-level data (n=254) were grouped into pooled HBO2 and sham intervention groups. Changes from baseline to post-intervention on PCS, PTSD, and neuropsychological measures were assessed using linear mixed models to evaluate main intervention and intervention-by-baseline PTSD effects. Potential dose-response relationships to oxygen partial pressures were investigated. Intervention effects from three other published studies with summary-level participant data (n=135) were also summarized..

RESULTS:

Pooled DoD data analyses indicated trends toward improvement favoring HBO2 for PCS (Rivermead Total Score: -2.3, 95% CI [-5.6, 1.0], p=0.18); PTSD (PTSD Checklist Total Score: -2.7, 95% CI [-5.8, 0.4], p=0.09); and significant improvement in verbal memory (CVLT-II Trial 1-5 Free Recall: 3.8; 95% CI [1.0, 6.7], p=0.01). A dose-response trend to increasing oxygen partial pressure was also found, with a greater HBO2 effect in mTBI-associated PTSD suggested. The direction of results was consistent with other published studies.

CONCLUSION:

A definitive clinical trial, with an appropriate control group, should be considered to identify the optimal HBO2 dosing regimen for individuals with mTBI-associated PTSD ± PCS.

• Authors: Brett B Hart, Lindell K Weaver, Ashutosh Gupta, Steffanie H Wilson, Amarnath Vijayarangan, Kayla Deru, Donald Hebert
• Journal: Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc (Undersea Hyperb Med) 2019 BIMA Special Edition No. Feb Vol. 46 Issue 3 Pg. 353-383 ISSN: 1066-2936 [Print] United States
• PMID: 31394604 (Publication Type: Journal Article, Systematic Review)
• Copyright: Copyright© Undersea and Hyperbaric Medical Society.

Chemical References

• Oxygen

Topics

• Adult
• Brain Concussion (complications)
• Checklist
• Female
• Humans
• Hyperbaric Oxygenation
• Linear Models
• Male
• Memory
• Mental Recall
• Middle Aged
• Military Personnel
• Neuropsychological Tests
• Oxygen
• Partial Pressure
• Post-Concussion Syndrome (complications, therapy)
• Quality of Life
• Sensitivity and Specificity
• Stress Disorders, Post-Traumatic (complications, therapy)
• Treatment Outcome
• United States
• United States Department of Defense
• Young Adult