Some Say TBI Cure is In the Air

It seems the stuff of science fiction.

Take a patient with a wound or injury and place him in a chamber where he is exposed to 100 percent pure oxygen for up to one to two hours, and the wound miraculously heals.

But take the "fiction" out of the science and it’s now accepted medicine in cases of fractures, burns, severe blood loss, carbon monoxide poisoning and a half-dozen other injuries or conditions.

And some doctors say the treatment, dubbed "hyperbaric oxygen therapy," can be useful to veterans suffering one of the signature wounds of the wars in Iraq and Afghanistan -- traumatic brain injury.

"HBOT stimulates growth and repair of any chronic wound, and TBI is a wound," said Dr. Paul Harch of the International Hyperbaric Medical Association, who last month lobbied for the treatment before the House Veterans Affairs Committee.

The therapy involves the patient inhaling 100 percent oxygen while inside a hyperbaric chamber that is pressurized up to three times normal atmospheric pressure. Patients may undergo any number of HBOT sessions over a period of months or more than a year, depending on the severity of the brain injury.

According to Harch, oxygen molecules shrink under the hyperbaric pressure and dissolve more easily and quickly into all body fluids, including the cerebrospinal fluid in which the brain "floats." Where oxygen normally is carried throughout the body only by red blood cells, hyperbaric oxygen therapy makes every fluid in the body an oxygen delivery system.

For its part, the agency charged with taking care of veterans is unsure whether to add HBOT to the list of treatments for men and women suffering from TBI.

Officials representing the Department of Veterans Affairs at the July 21 hearing told committee chairman Rep. Bob Filner, D-Calif., that they would provide him with additional information later on the question of HBOT, as well as other possible TBI treatments.

And in a January 2010 assessment of its use on TBI patients, the department said the jury is still out.

"Several case reports suggest positive outcomes for patients with TBI, but these studies were inconclusive for determining effectiveness as they were not randomized, controlled or blinded studies," the department wrote. "Therefore it is unknown whether individual case reports of recovery are due directly to [HBOT] … or natural recovery of each individual."

The Pentagon does plan to do a study of the hyperbaric treatment on about 300 TBI patients beginning early next year. The study, to be carried out at five Army and Marine Corps bases, will take about 18 months to complete, according to the Defense Department. Some of the Soldiers and Marines will be treated with pure oxygen and others with regular air.

But Harch said there have already been four military studies showing the benefits of HBOT for traumatic brain injury. He said the Air Force has treated a dozen active-duty Airmen who suffered TBI with hyperbaric oxygen therapy and results have been positive.

In one case study Harch presented to the committee, a medical team led by an Air Force colonel offered a favorable assessment of HBOT after treating two Airmen who had suffered traumatic brain injury from an IED explosion in Iraq in January 2008.

The medical team began administering the HBOT after six months of testing showed the Airmen’s conditions were deteriorating. Their conditions improved after they began HBOT treatments, according to a report by Col. James Wright, who was head of Hyperbaric Medicine Research at Brooks Air Force Base, Texas. Nine months after the treatments, doctors determined the Airmen’s brain function had returned "to pre-injury baseline levels."

"It seems unlikely to the authors," the medical team wrote in the report, "that any explanation other than the [HBOT] can be offered for their improvements."