Hyperbaric oxygen – the bridge from coma to recovery

Hyperbaric oxygen – the bridge from coma to recovery

“Uncle, come and follow my instructions and do the movements. Put your hands up, good, put your hands down, good, very good, you are great”. When the family saw that the patient was able to follow the nurse’s instructions to do the movements, they shed tears of excitement: “Thank you so much, he finally woke up.” This is the story of a heavy traumatic brain injury patient who miraculously recovered after two courses of comprehensive hyperbaric oxygen therapy after being in a coma for a month, when the family was almost desperate.

There is no doubt that it is the hyperbaric oxygen therapy that built the bridge for the patient’s rapid recovery to recover so well in a short period of time.

Introduction of the disease: one wave is not yet calm, another wave is rising again.

Introduction of the disease: one wave is not yet calm, another wave is rising again.

Disease description: one wave is not over, another wave is over

A 74-year-old man fell from a height and immediately fell into a coma, and was rushed to the local hospital, where he was diagnosed with traumatic heavy craniocerebral injury. The patient underwent “subdural hematoma removal, decompression with debridement and tracheotomy” in the local hospital. After surgery, the patient remained in a coma. During the treatment period, serious complications such as secondary cerebral hemorrhage, lung infection, right pleural effusion and hypoproteinemia appeared, which undoubtedly added to the patient’s overall condition. The family did not give up the treatment and came to our neurosurgery department with the intention of trying for a better treatment effect, and further wake-up and rehabilitation treatment. On admission: GCS score: 7, waking coma, tracheotomy status. There was a cranial defect with an area of about 12×12㎝2 on the left frontotemporal roof. The pupils were unequal in size bilaterally, the left side was about 4 mm in diameter with a dull reflex to light, the right side was about 2 mm in diameter with a sensitive reflex to light. There was resistance in the neck. After pressure orbital stimulation, the limbs showed hyperextension response. The muscle tone was increased and the muscle strength examination was uncooperative. After standardized and careful treatment in our neurosurgery department, the patient’s condition was relatively stable, and skull repair surgery was performed. At the same time of conventional treatment, a hyperbaric surgeon was consulted to exclude contraindications, and hyperbaric oxygen therapy, acupuncture, physiotherapy, rehabilitation and other comprehensive treatments were started on the same day.

Hyperbaric Oxygen Therapy Program

Considering the patient’s age, sputum, previous underlying diseases such as “hypertension and coronary heart disease”, and in a tracheotomy state and lung infection. In order to prevent cross-infection and to deal with accidents in time, we adopted a personalized oxygen treatment plan of “one person accompanying the cabin, one cabin for each person” and prepared a sputum suction device in the cabin. After special treatment, the front end of the oxygen inhalation tube was connected to the tracheotomy with a tee. Treatment pressure: 2.0 ATA, 105 minutes of total treatment, 20 minutes of pressurization, 15 minutes of decompression, 60 minutes of oxygen inhalation (20 minutes × 3), 10 minutes of rest in between, once a day.

The effect of hyperbaric oxygen therapy: the wood is dry

After 20 times of hyperbaric oxygen treatment and simultaneous administration of acupuncture, physiotherapy, rehabilitation and other comprehensive treatments, the patient’s status showed a significant improvement. From coma to consciousness, from commanding actions to speaking simple words, from walking with assistance to walking slowly on his own. As friends and relatives said, “If you don’t know the details, you can’t tell that this old man has just had a serious illness just by looking at his appearance.

The following pictures show the patient’s gradual recovery after the hyperbaric oxygen treatment.

After the first hyperbaric oxygen treatment, the patient’s pupils were equally large and round, and his reflexes to light were more sensitive than before.

After the 7th hyperbaric oxygen treatment, the patient was clear, and could nod and shake his head to indicate, the muscle strength of the right limb was grade III, and he could sit up in bed with the help of his family.

After the 14th hyperbaric oxygen treatment, the tracheotomy was sealed, the patient could say one or two words, and the muscle strength of the right limb was grade IV and could walk with the help of crutches or family members.

After the 19th hyperbaric oxygen treatment, the patient could walk alone and speak short sentences.

After discharge from the hospital, the patient was able to move freely and take care of himself by telephone.

The mechanism of hyperbaric oxygen therapy for craniocerebral injury

1、Hyperbaric oxygen therapy increases the partial pressure of oxygen in brain tissues, blood vessels and cerebrospinal fluid to improve the blood oxygen content of the body and correct the hypoxic state of brain tissues caused by craniocerebral injury.

2、Hyperbaric oxygen therapy increases the permeability of the blood-brain barrier and improves blood circulation by improving blood oxygen tension. 3、Hyperbaric oxygen therapy promotes the regeneration of new capillaries and accelerates the establishment of collateral circulation by stimulating the growth of vascular fibroblasts and the formation of collagen fibers.

4、Hyperbaric oxygen therapy reduces brain edema by lowering intracranial pressure, blocking the vicious cycle of brain cell hypoxia, edema and metabolic disorders.

5、Hyperbaric oxygen therapy enhances neural activity by increasing blood flow in the vertebral artery and activating the activation system of the superior brainstem reticular formation.

6、Hyperbaric oxygen therapy promotes neurological recovery by increasing the aerobic metabolism of cell mitochondria and inducing new side branches and synapses in axons.

In the end

The principle of hyperbaric oxygen therapy is the earlier the better. When there are no contraindications and the vital signs are relatively stable, hyperbaric oxygen therapy should be performed as early as possible. Coma is not terrible, but the key is to promote waking up as early as possible to ensure the smooth development of the disease for the better. Hyperbaric oxygen plays a unique efficacy in the treatment of craniocerebral injury, and its early application to different degrees of craniocerebral injury can promote better recovery of patients to the maximum extent. Even if the intervention is late, do not give up the opportunity of hyperbaric oxygen therapy. Like the successful cases shared in this article, many similar miracles are being performed all over the world, bringing benefits to more patients and families.