Effects of Normobaric Hyperoxia in Traumatic Brain Injury: A Randomized Controlled Clinical Trial

Background: Traumatic brain injury (TBI) is one of the important causes of morbidity and mortality throughout the world, especially in young people. In recent years normobaric hyperoxia has become an important and useful step for recovery and improvement of outcome in TBI. Objectives: The purpose of this study was to evaluate the effects of normobaric hyperoxia on clinical neurological outcomes of patients with severe traumatic brain injuries. We used the Glasgow outcome scale (GOS), barthel index, and modified rankin scale (mRS) to measure the outcomes of patients with TBI. Patients and Methods: Sixty-eight consecutive patients with severe TBI (mean Glasgow coma scale [GCS] score: ۷.۴) who met the inclusion criteria were entered in this randomized controlled clinical trial. The patients were randomized into two groups, as follows: ۱) experimental: received ۸۰% oxygen via mechanical ventilator in the first ۶ hours of admission, ۲) control: received ۵۰% oxygen by mechanical ventilator in the first ۶ hours of admission and then standard medical care. We measured the GOS, Barthel Index, and mRS at the time of discharge from hospital and reassessed these measurements at the ۶-month follow-up after injury. Results: According to our study, there were no significant sex or age differences between the two groups (P = ۰.۵۹۵ and ۰.۰۷۴). The number of days in the intensive care unit (ICU) in the control group and experimental group were ۱۱.۴ and ۹.۴ days, respectively (P = ۰.۲۸), while the numbers of days of general ward admission were ۱۳.۹ and ۱۱.۴ days (P = ۰.۱۳۷) respectively. The status of GOS at time of discharge were severe = ۱۳ and ۱۰, moderate = ۱۶ and ۱۹, and low = ۵ and ۵ in the control and experimental groups, respectively (P = ۰.۷۲۳); ۶ months after injury, the scores were as follows: moderate = ۱۶ and ۹, low = ۱۵ and ۲۵, and severe = ۳ and ۰ (P = ۰.۰۲۴). The Barthel index scores in the control and experimental groups were ۵۹.۷ and ۶۳.۹ at time of discharge (P = ۰.۳۶۹) and ۸۲.۷ and ۹۱.۳ at ۶ months after injury (P = ۰.۰۱۸), respectively. The mRS results were ۲.۶ and ۲.۳ at time of discharge (P = ۰.۳۲۰) and ۱.۶ and ۰.۷ at ۶ months after injury (P = ۰.۰۰۶) for the control and experimental groups, respectively. Conclusions: According to the results of this study, oxygen therapy by mechanical ventilator in the first ۶ hours after injury in patients with severe TBI can improve the final GOS, Barthel index, and mRS scores. It could also improve long-term outcomes and enhance rehabilitation and the quality of life.

Keywords:

Brain Injuries , Oxygen Inhalation Therapy , Hyperbaric Oxygenation , Glasgow Outcome Scale