Is Hyperbaric Oxygen Therapy Effective for Traumatic Brain Injury? A Rapid Evidence Assessment of the Literature and Recommendations for the Field

OBJECTIVE: This systematic review examines the efficacy of hyperbaric oxygen (HBO(2)) for traumatic brain injury (TBI) to make evidence-based recommendations for its application and future research. METHODS: A comprehensive search was conducted to identify studies through 2014. Methodological quality was assessed and synthesis and interpretation of relevant data was performed. RESULTS: Twelve randomized trials were included. All mild TBI studies demonstrated minimal bias and no statistically significant differences between HBO(2) and sham arms. Statistically significant improvement occurred over time within both groups. Moderate-to-severe TBI studies were of mixed quality, with majority of results favoring HBO(2) compared with “standard care.” The placebo analysis conducted was limited by lack of details. CONCLUSIONS: For mild TBI, results indicate HBO(2) is no better than sham treatment. Improvements within both HBO(2) and sham groups cannot be ignored. For acute treatment of moderate-to-severe TBI, although methodology appears flawed across some studies, because of the complexity of brain injury, HBO(2) may be beneficial as a relatively safe adjunctive therapy if feasible. Further research should be considered to resolve the controversy surrounding this field, but only if methodological flaws are avoided and bias minimized.