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Dr. Jim Wright: Hyperbaric oxygen for brain injury

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Dr. Jim Wright (retired USAF Colonel) present his findings on the use of hyperbaric oxygen therapy at the 2011 First Annual Independent Football Veterans Conference in Las Vegas.

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Dr. Jim Wright: Hyperbaric oxygen for brain injury

  1. 1. Hyperbaric Oxygen for Brain Injury James K. Wright, MD, Col, USAF (Ret)
  2. 2. Traumatic Brain Injury in Active Duty and Veterans <ul><li>300,000+ cases from OEF/OIF (19.5%) </li></ul><ul><ul><li>RAND Report 2008 </li></ul></ul><ul><li>300,000+ have PTSD (18.5%) </li></ul><ul><li>TBI makes PTSD more likely </li></ul><ul><li>About 2/3 of PTSD have TBI also </li></ul><ul><li>< ½ get “minimally adequate care” </li></ul>
  3. 3. Example of TBI impact assessment in NFL Player <ul><li>NFL football player with concussion </li></ul><ul><li>Loss of about 2% of the fiber tracts in the region of the corpus callosum. </li></ul>Enlarged Fiber Tract showing fibers from concussive event Courtesy Dr. Walter Schneider, U Pittsburgh Area of Tissue change Fibers passing through areas
  4. 5. 1 st 2 Airmen Treated for TBI <ul><li>2 USAF Airmen </li></ul><ul><li>Previously healthy </li></ul><ul><li>No Hx head injury </li></ul><ul><li>IED 13 Jan 2008 </li></ul><ul><li>In M915 14-ton truck </li></ul><ul><li>Concussive injuries (“bell rung”) </li></ul><ul><li>No LOC </li></ul><ul><li>No Amnesia </li></ul>
  5. 6. Symptoms <ul><li>Immediate </li></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Slight confusion </li></ul></ul><ul><ul><li>Assessed </li></ul></ul><ul><ul><li>Off line for 2-3 days </li></ul></ul><ul><li>Delayed – 3 weeks + </li></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Sleep disturbances </li></ul></ul><ul><ul><li>Headaches </li></ul></ul><ul><ul><li>Memory difficulties </li></ul></ul><ul><ul><li>Cognitive difficulties </li></ul></ul><ul><ul><li>Clumsy </li></ul></ul><ul><li>Threatened with job loss </li></ul>
  6. 7. Results of HBOT for TBI Airman B Airman C Date of IED 13 Jan 2008
  7. 8. Symptom resolution <ul><li>Headaches </li></ul><ul><li>Sleep disturbances </li></ul><ul><li>Fatigue </li></ul><ul><li>Irritability </li></ul><ul><li>Memory loss </li></ul><ul><li>Fine motor reactions </li></ul><ul><li>Cognitive function </li></ul>Time
  8. 9. What HBOT is <ul><li>100% oxygen under pressure </li></ul><ul><li>1.5 – 2/0 ATA for brain injury </li></ul><ul><li>40-80 1 hr treatments </li></ul><ul><li>1-2 HBOT per day </li></ul><ul><li>Used for more than 100 years for brain injury </li></ul>
  9. 10. How it works - 5,769+* ways <ul><li>Upregulates growth factors </li></ul><ul><li>Reduces edema </li></ul><ul><li>Promotes neural pathway growth </li></ul><ul><li>Activates senescent neurons </li></ul><ul><li>Increases neuronal ATP </li></ul><ul><li>Downregulates inflammation </li></ul><ul><li>Reduces reperfusion injury </li></ul>*Rink C, Roy S, Khan M, Ananth P, Kuppusamy P, Sen CK, Khanna S. Oxygen-sensitive outcomes and gene expression in acute ischemic stroke. J Cereb Blood Flow Metab. 2010 Feb 10.
  10. 11. HBOT Indications <ul><ul><li>Air or gas embolism </li></ul></ul><ul><ul><li>Carbon monoxide poisoning </li></ul></ul><ul><ul><li>Gas gangrene </li></ul></ul><ul><ul><li>Traumatic ischemias – crush injury, compartment syndrome </li></ul></ul><ul><ul><li>Decompression sickness </li></ul></ul><ul><ul><li>Arterial insufficiencies </li></ul></ul><ul><ul><li>Severe anemia </li></ul></ul><ul><ul><li>Intracranial abscess </li></ul></ul><ul><ul><li>Necrotizing soft tissue infections </li></ul></ul><ul><ul><li>Refractory osteomyelitis </li></ul></ul><ul><ul><li>Delayed radiation injury </li></ul></ul><ul><ul><li>Compromised flaps and grafts </li></ul></ul><ul><ul><li>Acute thermal burn injury </li></ul></ul><ul><ul><li>Problem wounds </li></ul></ul><ul><ul><li>Retinal ischemic disease </li></ul></ul>HBOT has been used for >100 years to treat brain injury
  11. 12. Casey Owens Video <ul><li>Casey Owens video </li></ul>
  12. 13. NBIRR National Brain Injury rescue and Rehabilitation Project <ul><li>1000 patients with mTBI </li></ul><ul><li>17+ centers </li></ul><ul><li>All receive HBOT </li></ul><ul><li>Early results encouraging </li></ul><ul><li>35 participants treated (Mar 2011) </li></ul><ul><li>All participants have improved </li></ul><ul><li>Most improved in every measure </li></ul><ul><li>Most improved substantially </li></ul><ul><li>No participants worsened </li></ul><ul><li>Results are durable </li></ul>
  13. 14. Results <ul><li>1 st 12 consecutive patients with TBI </li></ul><ul><li>All received HBOT </li></ul><ul><li>All improved in nearly every measure </li></ul><ul><li>Results are % change in ANAM mood scores </li></ul>
  14. 15. ANAM Results <ul><li>1 st 12 consecutive patients with TBI </li></ul><ul><li>All received HBOT </li></ul><ul><li>All improved in nearly every measure </li></ul><ul><li>Results are % improvement in ANAM scores </li></ul>
  15. 16. Comparison to Pre-Injury Status N=4
  16. 17. ANAM Scores pre-injury, post injury, post HBOT 100% 50% 0
  17. 18. Do HBOT recipients get back to normal?
  18. 19. PHQ-9 Test
  19. 20. PHQ-15 Test
  20. 21. What we have learned <ul><li>Every patient with TBI treated with HBOT has improved </li></ul><ul><li>Improvement is durable </li></ul><ul><li>The earlier you treat, the better the result </li></ul><ul><li>More severe TBI requires more HBOT </li></ul><ul><li>HBOT reduces the need for medication </li></ul><ul><li>PTSD associated with TBI (2/3 of military PTSD cases) improves with HBOT </li></ul>
  21. 22. Questions?

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