title: Hyperbaric oxygen: B-level evidence in mild traumatic brain injury clinical trials.
abstract: OBJECTIVE
  First, to demonstrate that B-level evidence exists for the use of hyperbaric oxygen therapy (HBOT) as an effective treatment in mild to moderate traumatic brain injury/persistent postconcussion syndrome (mTBI/PPCS). Second, to alert readers and researchers that currently used pressurized air controls (≥21% O2, >1.0 ATA) are therapeutically active and cannot be utilized as sham controls without further validation.
  
  
  METHODS
  Review of published, peer-reviewed articles of HBOT prospective and controlled clinical trials of mTBI/PPCS symptoms.
  
  
  RESULTS
  Published results demonstrate that HBOT is effective in the treatment of mTBI/PPCS symptoms. Doses of oxygen that are applied at ≥21% O2 and at pressures of >1.0 ATA produce improvements from baseline measures. Some of the recently published clinical trials are mischaracterized as sham-controlled clinical trials (i.e., sham = 21% O2/1.2-1.3 ATA), but are best characterized as dose-varying (variation in oxygen concentration, pressure applied, or both) clinical trials.
  
  
  CONCLUSIONS
  Hyperbaric oxygen and hyperbaric air have demonstrated therapeutic effects on mTBI/PPCS symptoms and can alleviate posttraumatic stress disorder symptoms secondary to a brain injury in 5 out of 5 peer-reviewed clinical trials. The current use of pressurized air (1.2-1.3 ATA) as a placebo or sham in clinical trials biases the results due to biological activity that favors healing.
authors: From the Brain Health & Healing Foundation (X.A.F.), Seattle; and Swedish Medical Center (J.K.W.), Wound Healing & Hyperbarics, Edmonds, WA. bhif.figueroa@gmail.com.
authors: Xavier A
authors: XA
authors: Figueroa
authors: From the Brain Health & Healing Foundation (X.A.F.), Seattle; and Swedish Medical Center (J.K.W.), Wound Healing & Hyperbarics, Edmonds, WA.
authors: James K
authors: JK
authors: Wright
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000628:therapy*; D002986:Clinical Trials as Topic; D006801:Humans; D006931:Hyperbaric Oxygenation