Efficiency of hyperbaric oxygenation in complex rehabilitation of soldiers with traumatic brain injury: prospective study

Abstract

OBJECTIVE: Evaluate the effect of hyperbaric oxygenation course on indicators of central hemodynamics, heart-rate variability and ability to concentrate and switch attention in soldiers with traumatic brain injury. MATERIALS AND METHODS: The main group contained 50 patients with combat traumatic brain injury, aged 25-45, whose comprehensive treatment course included hyperbaric oxygenation. The control group consisted of 20 patients, treated with medical therapy under the clinical protocol. Hyperbaric oxygenation treatment was carried out in BLKS-303 MK pressure apparatuses in the 0.3–0.7 ati mode with an isopression exposure of 40 min. The course of hyperbaric oxygenation included 10±2 sessions per day. The indicators of heart-rate variability and central hemodynamics were measured. Bourdon proofreading sample was used to assess alertness and ability to switch attention. Statistics. Statistical analysis of data was performed using “Statistica for Windows 6.5” program. Comparisons are shown as median values (Me) and quartile range (LQ÷UQ) (25% and 75% percentile). Criteria of significance was considered p<0,05. the Mann-Whitney test was used to compare quantitative indicators in the main and control groups, the Wilcoxon T test was applied when studying the dynamics of change in indicators in the study groups. RESULTS: Including hyperbaric oxygenation in the complex therapy of patients with combat traumatic brain injury led to significant reduction in indicators of sympathetic activity - mode amplitude - up to 35,7 % (29,5÷48,0), decrease of tension index up to 116,5 %/с2  (99,0÷122,0) and recovery of vegetative equilibrium indicator LF/HF up to 2,8 (2,5÷4,3). Patients with hyperkinetic type of blood circulation in the main group, compared to the control group experienced significant reduction in stroke volume index to 41,8 (40,7÷54,8) ml/m2 cardiac index up to 4,6 (4,4÷5,2) kg*m/min/m2 , decreased energy expenditure for blood moving to 12,3 (12,3÷12,7) Wh/l. improve coordination is observed in 54 % of the main group in comparison with 34 % of the control group, reduced pathological reflexes - in 50 % of the main group, compared to 22 % of the control group, decrease in the severity of deep reflection disorders - in 55 % of the main group versus 28 % of the control group. Conducting Bourdon proofreading sample test after HBO course in the main group, compared to the control group showed significant error reduction from 12,7 (10,2÷14,6) to 4,2 (3,7÷5,2) (р<0,001); reliable error reduction from 11,8 (9,6÷12,8) to 8,4 (6,5÷10,2) (р<0,05) was noted in the control group. DISCUSSION: Early application of hyperbaric oxygenation in the complex therapy of patients with combat traumatic brain injury contributes to rapid normalization of central hemodynamics, decrease in the severity of impact on the sympathetic part of the autonomic nervous system, reduction in the degree of cardiac rhythm management centralization. Reliable regression of focal symptoms in the main group was accompanied by significant improvement in concentration and stability of attention, ability to switch it, compared to the control group. CONCLUTION: Including hyperbaric oxygenation in the complex treatment of traumatic brain injury can significantly increase therapy efficiency, resulting in faster restoration of impaired brain functions, memory and attention activation, normalizing the indicators of heart-rate variability and central hemodynamics, and promotes transition to a more economical operating mode according to the new level of oxygenation.