Hyperbaric Oxygen Therapy of Severe Traumatic Brain Injury in Children and Adolescents

Summary

Aim:
Recent studies have suggested that hyperbaric oxygen therapy (HBOT) might be a relatively safe and promising treatment for children patients with severe traumatic brain injury (TBI).

Patients and methods:
From June 2006 to February 2010 we referred seven (age 2–17 years) of the 15 children (11 male) after severe TBI (GCS ≤8) treated at our PICU to HBOT. We analysed Glasgow Coma Scale (GCS) before and after acute treatment, Paediatric Risk of Mortality (PRISM) on admission to PICU, Glasgow Outcome Scale (GOS) and endocrine functions after 6 months from an injury in all admitted patients. The patients received HBOT in a multiplace chamber. Oxygen (100% O2, compression to 2 ATA) was delivered to patients over 80 min every 24 h.

Results:
HBOT was indicated in patients who suffered prolonged disturbance of consciousness after an acute treatment of the TBI. The median interval from the injury to receiving HBOT was ± 17.7 days (10–22 days). GCS after an acute treatment and PRISM score on admission of children receiving HBOT were significantly different from children without HBOT (p <0.001 and p = 0.003, respectively). The patients received between 3 and 22 courses of HBOT (mean of ±10.9 sessions per patient). Adverse events were observed in three patients. There was no statistical difference in GOS between HBOT treated and untreated patients after six months from the injury. There were no changes in endocrine function in any of the patients.

Conclusion:
HBOT appears to be beneficial as an adjunctive treatment in children and adolescents with disturbed consciousness following an acute treatment of severe TBI with no major adverse events.

Key words:
traumatic brain injury – hyperbaric oxygen therapy – neuroprotective effect – endocrine function