Introduction
Hyperbaric oxygen therapy (HBOT) is a non-invasive method of treating patients in a specially designed hyperbaric chamber, where they breathe 100% oxygen administered at a pressure higher than local atmospheric pressure (Narożny W. et al., 2007).
The use of hyperbaric oxygen in patient therapy dates back to the 17th century, when C. Henshaw, a British physician and physiologist, designed the first hyperbaric chamber (Jain KK et al. 2004). I. Boerema, a Dutch surgeon, is considered the father of modern oxygen hyperbaric oxygen therapy. It is the most effective method of supplying oxygen to all body cells, even those around which the blood supply has been disordered. During therapy the conditions inside the hyperbaric chamber cause the blood oxygen partial pressure to increase due to a significant increase in its solubility in the plasma. Hyperbaric oxygen therapy can be successfully applied to patients with hard-to-heal wounds (in the course of diabetic foot syndrome, after injuries and radiotherapy), chronic osteomyelitis, bacterial tissue infection, carbon monoxide poisoning and extensive burns (second- and third-degree burns covering over 20% of the body surface area). For therapeutic purposes the pressure inside the chamber should exceed 1.4 atmosphere absolute (ATA) to increase the amount of oxygen supplied to cells in the body. During treatments a pressure of 2.5 ATA is usually applied (Jain KK et al., 2004; Mathieu D 2006). Thanks to hyperbaric oxygen therapy (2.0-2.8 ATA) oxygen concentration in healthy tissues can be increased to as much as 1,000 mmHg, whereas in wounds and hypoxic areas it can be increased up to 250 mmHg (Knefel G. et al., 2006).
Oxygen therapy is considered to be a safe and non-invasive method. However, there is a risk of respiratory toxicity (Lorrain-Smith effect: chest tightness or pain, cough, irritation or inflammation of the trachea and bronchi, apnoea and reduced vital capacity, damage to the alveolar epithelium and capillary endothelium, pulmonary oedema, atelectasis with hypoxia). Paul Bert effect, which may occur during HBOT, is described as a set of CNS symptoms: nausea, dizziness, hiccups, eyelid and facial tremor, vision and hearing disorders, hallucinations, breathing difficulty, fatigue, anxiety, loss of consciousness and tonic-clonic seizures. The most common contraindications for HBOT are: pneumothorax, emphysema with CO2 retention, some drugs (e.g. bleomycin), the presence of a pacemaker, epilepsy, fever, viral infections, spherocytosis (Szymańska B. et al., 2006).
In recent years this method of treatment has become more available and the list of indications where it has proved to be effective is longer. As early as 1976 there were reports on the possibility to use HBOT in CNS pathologies. It was then that Tishchenko noted that hyperbaric oxygen improved the cognitive functions and reduced the number of neurological complications in 20 patients treated in a hyperbaric chamber (Tishechenko et al., 1976). Hyperbaric oxygen therapy increases the metabolism of nerve cells, reduces intracranial pressure, improves the cognitive function and quality of life (Rockswold et al., 2010; Deng et al., 2018).
At the moment the possibility of using HBOT in the late period after TBI as a method supporting rehabilitation is an issue of interest.
The aim of the study was to analyse the case of a patient after a traumatic brain injury treated with HBOT during the rehabilitation period. This type of therapy is not widely used in Poland and any case of its use may be an interesting scientific report.