Abstract
BACKGROUND: Despite traumatic brain injury (TBI) being a leading cause of disability worldwide, it often results in long-term neurocognitive deficits. While conventional treatment options remain limited, hyperbaric oxygen therapy (HBOT) has been proposed as a potential adjunctive intervention due to its ability to enhance oxygen delivery and reduce inflammation. We performed a systematic review and meta-analysis to evaluate the efficacy of HBOT in improving neurocognitive outcomes for TBI patients. METHODS: PubMed, Embase, and Cochrane Central databases were searched for studies on HBOT efficacy in neurocognitive deficits in TBI. Statistical analysis was performed using RevMan v.5.4. A random-effects model was applied to pool mean differences (MDs) and 95% confidence intervals (P < 0.05). Risk of Bias 2 (RoB-2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tools were used to assess the risk of bias in included randomized controlled trials (RCTs) and non-randomized studies (NRSs), respectively. RESULTS: Across four studies (250 patients; mean age 25 years, 43% female), HBOT significantly improved multiple neurocognitive domains in TBI patients. The most pronounced improvements were observed in memory (MD 10.13, P < 0.00001) and attention (MD 7.99, P < 0.00001), with additional benefits in general cognition scores (MD 7.47, P = 0.003), executive function (MD 7.16, P = 0.002), information processing speed (MD 7.48, P = 0.01), and motor skills (MD 5.19, P < 0.00001). RCTs had a low risk of bias, while NRSs had a moderate risk of bias due to confounding. CONCLUSION: HBOT demonstrates potential in mitigating neurocognitive impairments associated with TBI. Proposed mechanisms underlying its effects include enhanced oxygenation, reduced inflammation and expression of matrix metalloproteinase, decreased brain swelling, and improved outcomes. However, larger trials with standardized protocols are needed to establish the optimal therapeutic role of HBOT in TBI management.