Trauma is a leading cause of death and morbidity in young adults and in the military (explosion-induced trauma), with more than 50% of deaths attributed to traumatic brain injury (TBI). The morbidity caused by traumatic brain injury has brought a huge burden to the family and the society. Surgical treatment, such as hematoma or contusion resection, is used to save life but does not improve prognosis. The general consensus is that effective treatment should focus on secondary brain injury. Previously, treatment focused on stabilizing blood and intracranial pressure (ICP). They usually involve the administration of neuroprotective drugs as well as rehabilitation training, although they ignore the hypoxic state of brain tissue after TBI.
Multiple studies have shown that the presence of secondary ischemic damage in brain tissue early in TBI is an important factor in morbidity and mortality. Therefore, oxygen-directed therapy guided by specific monitoring devices may help reduce mortality and thus improve outcomes in TBI patients. Previous studies have confirmed the theoretical feasibility of hyperbaric oxygen treatment and investigated the potential mechanisms and effects of hyperbaric oxygen treatment. Cells in the central nervous system (CNS) are entirely dependent on aerobic metabolism and require a large supply of oxygen. High metabolic rate is mainly related to neuronal signal transduction, such as synaptic transmission, action potential and neural excitability. With brain hypoxia, neuronal cell death becomes inevitable. Current promising research suggests that hypoxia is another therapeutic target in patients with TBI. Although the role of hyperoxia in severe brain injury is somewhat controversial, in our experience serious complications are rarely observed and are usually reversible.
Normobaric oxygen (NBO) and hyperbaric oxygen (HBO) are the two main accepted treatments, with hyperbaric oxygen treatment being significantly more effective. Hyperbaric oxygen treatment has been shown to reduce ischemic loss of hippocampal neurons and has been shown to improve neurobehavioral outcomes.
Accumulating evidence shows that hyperbaric oxygen treatment is a key factor in the treatment of TBI and occupies an important place in modern neurosurgery. We believe that hyperbaric oxygen treatment will be increasingly accepted by patients and recognized by clinicians. In addition to TBI, other cerebrovascular diseases, such as intracerebral hemorrhage and high-grade subarachnoid hemorrhage, also have treatment indications that significantly improve outcomes, although multisystem organ failure caused by irregular interventions has raised concerns. Although hyperbaric oxygen treatment has entered a mature stage, the mechanism and efficacy of hyperbaric oxygen treatment should be further investigated, both in preclinical and clinical studies, because it can provide a clinically promising treatment for TBI.
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