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.