Selasa, 25 Agustus 2015
Hyperbaric Oxygen Study Shows Potential Benefit for Patients With Traumatic Brain Injury Google+ Share with LinkedIn MINNEAPOLIS, Jan. 4 /PRNewswire-USNewswire/ -- A 5-year study of patients with severe traumatic brain injury conducted at Hennepin County Medical Center in Minneapolis shows significant benefit of hyperbaric oxygen therapy to improve brain metabolism and its ability to recover from injury. The results were recently published in the Journal of Neurosurgery. Every year, more than 1.4 million Americans sustain a traumatic brain injury (TBI) - the leading cause of death and disability in children and young adults. Those who survive often face months or even years of therapy, and sometimes the damage to the brain is irreversible. Decreased utilization of oxygenated blood to brain tissue immediately after the injury is often to blame. Cells need oxygen to fuel metabolism for cellular growth and repair. Healthy brains produce their own energy to maintain brain tissue and keep the rest of the body doing what it's supposed to do. That includes automatic processes like breathing and circulation, as well as voluntary actions like walking and talking. After a traumatic brain injury, the brain itself needs care. Barriers to blood flow can be compromised from the impact of the injury itself, and then when the brain swells inside the skull, a secondary injury can occur that causes even more brain damage. "There's a direct correlation between clinical outcome and the degree to which the brain's metabolism is restored," explains one of the study's authors, neurosurgeon Gaylan Rockswold, MD. "In previous research we learned that the brain's energy production is improved and maintained with hyperbaric oxygen treatment, but this study confirms that hyperbaric oxygen treatment has a major impact in terms of increased energy production." Within 24 hours after injury, eligible patients for the study were randomized into three groups: One group received "normobaric" treatment: oxygen delivered at the patient's bedside; another group received hyperbaric treatment in Hennepin County Medical Center's hyperbaric oxygen chamber; and a third (control) group did not receive additional oxygen therapy. All groups received the intensive standard of care for brain injury consistent with good clinical practice. The patients who received higher levels of oxygen (hyperoxia) via the hyperbaric oxygen chamber were found to have a marked increase in positive brain metabolism when compared to the normobaric and control group. "Our goal was to evaluate the brain's metabolism and intracranial pressure, and whether or not too much oxygen posed a concern with hyperbaric oxygen treatment in these patients," said Dr. Rockswold. "The results indicate that hyperbaric oxygen treatment was found to significantly enhance the brain's energy production and reduce intracranial pressure without any toxic effects on the brain or lungs from too much oxygen." This research provides important preliminary data for a National Institutes of Health (NIH) supported multicenter trial. NIH trials directly assess the ability to improve clinical outcomes, which is the final step needed to change standard clinical processes. Currently standard clinical practice does not include hyperbaric oxygen for traumatic brain injury. "TBI is not only devastating for the patient, it's also heart wrenching for his or her family. We couldn't be more pleased about the impact this study will have for patients with traumatic brain injury." The Traumatic Brain Injury Center at Hennepin County Medical Center offers comprehensive, multidisciplinary patient care education and research to serve people who have sustained a traumatic brain injury. Providing a full range of state-of-the-art medical and rehabilitative services, HCMC's expertise spans the entire continuum of care for adult and pediatric TBI patients, from prevention to emergency care, neurosurgery, critical care, rehabilitation and the Mild to Moderate Traumatic Brain Injury Clinic. About Traumatic Brain Injuries Each year, more than 1.5 million Americans sustain a traumatic brain injury (TBI). In Minnesota, nearly 100,000 brain injuries occur annually. A large percentage of those injuries are mild to moderate cases and often go untreated. As a Level 1 Trauma Center, Hennepin County Medical Center admits and treats the most traumatic brain injuries in the state. More information about HCMC's Traumatic Brain Injury Center can be found at www.savethisbrain.org. The state's only permanent, fully accredited hyperbaric chamber is located at Hennepin County Medical Center. HCMC's Hyperbaric Medicine program is one of only 60 programs in the country to achieve accreditation by the Undersea and Hyperbaric Medical Society (UHMS). The multi-chambered unit is fully staffed year round and is used for a variety of critical and chronic medical conditions, including treatment for carbon monoxide poisoning. Hennepin County Medical Center is a Level 1 Trauma Center and public teaching hospital repeatedly recognized as one of America's best hospitals by U.S. News & World Report. SOURCE Hennepin County Medical Center RELATED LINKS http://www.savethisbrain.org
HBOT and Chronic Carbon Monoxide Poisoning Carbon monoxide poisoning is a protean disease characterized by hypoxic injury, metabolic poisoning of cells, reperfusion injury mediated by damage to the inside lining of blood vessels, brain lipid peroxidation, and other pathologic processes. Hyperbaric oxygen therapy is beneficial when delivered hyperacutely, but the dose is less certain when there is delay to treatment. Dr. Harch has presented information at the UHMS meeting showing the benefit of low-pressure HBOT and SPECT brain imaging in the treatment of chronic persistent or delayed neuropsychiatric sequelae of CO poisoning (26). In addition, he has successfully used SPECT brain imaging in acute CO poisoning to help track the patient's progress. Below is an example of such a case. Case Presentation: The patient is a 44 year old male who sustained a 4 hour exposure to propane and carbon monoxide while working in a closed space with a poorly tuned propane-powered forklift. He was taken to a nearby hospital where he was placed on high flow oxygen for 2 hours. Carboxyhemoglobin before discharge was 14%. Over the next 72 hours his headaches, lethargy, dizziness, and cognitive symptoms intensified, prompting referral for evaluation. The patient was treated on a course of HBOT through clinical plateau, but then presented 6 months after the poisoning with persistent neuropsychiatric sequelae. Figure 1 shows SPECT brain imaging on a dual-head scanner immediately prior to first retreatment HBOT. Note the diffuse patchy heterogenous pattern compared to the normals above. Maximum brain blood flow (pixel count) is 258. This is the amount of radioactivity in the smallest measured piece of brain tissue and is proportional to brain blood flow; the higher the pixel count, the higher the blood flow. Color scale is yellow, red, green, blue, purple, black from highest to lowest flow. Images proceed from the base of the brain in the left upper corner to the top of the brain in the lower right hand corner (opposite of the convention above). Figure 2 is a repeat SPECT scan five days after Figure 1 and four days after a single low pressure HBOT. Note the global smoothing (more normal pattern) and improvement in average blood flow (more yellow) while only showing a minimal increase in maximum pixel count (265). The patient underwent an additional course of low-pressure HBOT with improvement in symptomatology and psychometric testing that was reflected in improvement on SPECT at the completion of treatment, Figure 3. Again, note the global smoothing effect of HBOT and improvement in overall blood flow with maximum pixel count of 330. The lesser amount of yellow on Figure 3 is misleading and due to computer scaling. To more accurately compare scans 1 and 3, Figure 4 shows Figure 3 on the same maximum pixel scale, 258, as Figure 1. The dramatic improvement in overall brain blood flow is now very clearly demonstrated. 26. Harch PG, et al. HMPAO SPECT brain imaging of acute CO poisoning and delayed neuropsychological sequelae (DNSS). Undersea and Hyperbaric Medicine, 1994;21(Suppl):15.