Research still in early stages; doctors say oxygen use boosts energy
levels
Oxygen therapy in a pressurized hyperbaric chamber appears to help patients recover from severe traumatic brain injuries, according to Hennepin County Medical Center research released Monday.
While the study didn't specifically prove that patients fared better long-term, it did show that energy levels were much higher in the brains of patients receiving hyperbaric oxygen than for those receiving standard treatment.
That is significant, said Dr. Gaylan Rockswold, the medical center's chief of neurosurgery, because there is a proven link between energy metabolism in the brain and recovery. "Improved energy production results in improved outcomes," he said.
Doctors at the Hennepin County hospital hope the study is a first step toward making hyperbaric oxygen a standard emergency treatment for patients who suffer severe brain injuries through car accidents or other trauma. The next step — pending a $23 million grant request to the National Institutes of Health — is to compare the long-term recoveries of patients receiving hyperbaric oxygen with patients who don't receive it.
Rockswold said there is a strong economic case for hyperbaric oxygen if it proves effective. Right now, roughly a third of patients with severe brain injuries die, while others suffer long-term brain damage. Only 40 percent of the patients have what doctors consider favorable recoveries — meaning they regain most of their mental and physical capabilities.
If that success rate could be increased to 55 percent through the use of hyperbaric oxygen, Rockswold said, spending on long-term care for patients whose brain injuries result in permanent disabilities would be reduced. The savings would far exceed the cost of adding hyperbaric chambers in more U.S. hospitals.
The long-term care cost "is so big," Rockswold said, "and that doesn't even include the loss of productivity in these people."
Hennepin County Medical Center is a leader nationally in the medical use of hyperbaric chambers, which administer 100 percent oxygen at an increased level of atmospheric pressure. The hospital's multi-room chamber was featured last month in media reports about the treatment of a St. Paul couple who nearly died from carbon monoxide exposure. The high-pressure oxygen treatment helped to eject the carbon dioxide from their bloodstreams.
The brain injury study of 69 patients used smaller, individual chambers. The goal was to place some patients in the sealed chambers within 24 hours of their traumatic brain injuries — but only after their conditions were stabilized and other wounds were treated. Comparison patients in the study either received oxygen therapy in normal atmospheric conditions, or received standard treatment with no oxygen therapy at all.
Erin Duffy still has memory shortfalls and a quicker temper since the July 2007 car accident in downtown Minneapolis that sent her to Hennepin County Medical Center with a head wound. Doctors performed emergency surgery to relieve the swelling and pressure in her brain, and then gave the Shoreview native hyperbaric oxygen as part of the study.
The 26-year-old considers herself fortunate; after a slow recovery and rehabilitation, she finished her training as a dietitian and now works with patients at a Chicago hospital. "Not everyone has as good of an outcome as I did," she said. "If that has to do with the oxygen, then everyone should get that option."
HCMC's study results, published in the Journal of Neurosurgery, found roughly a third more energy consumption in the brains of patients receiving hyperbaric oxygen. Those patients also showed less brain swelling, which can be a deadly complication of traumatic brain injuries.
The theory behind this research is that a traumatic brain injury triggers a shutdown of energy production at the very time more energy is needed to prevent the death of brain cells. Rockswold said a substantial infusion of oxygen is needed to disrupt this "energy crisis" in the brain.
Despite the early success, Rockswold said, HCMC wouldn't yet be using hyperbaric oxygen as standard treatment of its traumatic brain injury patients. The larger comparative study is still needed. If funded by the National Institutes of Health, the study would involve a dozen U.S. medical centers and data analysis by independent experts in Houston.
"In order to get the medical and scientific community to buy this," he said, "we need to do it right."
Jeremy Olson can be reached at 651-228-5583.
source: twincities
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