Hypoxia and hyperbaric oxygen therapy: a review

Very good article to read: Hypoxia and hyperbaric oxygen therapy: a review

« The manner in which HBOT affects the body as a conse- quence of primary and secondary effects should be under- stood. The primary, or direct effects, include correcting the hypoxic condition by increasing oxygen delivery and tension, antimicrobial activity, and the attenuation of the HIF-mediated effects. The secondary effects include indirect consequences of HBOT, such as reducing the formation of ROS, increasing the body’s ability to heal, vasoconstriction, and angiogenesis, as well as subduing inflammation.57 The therapeutic pressures used in HBOT are described in terms of atmospheres of pressure ranging from 1.5 to 3.0 atm. In general, lower partial pressures are favored to avoid baro- trauma to the lungs, ear drums, sinuses, and teeth. Oxygen toxicity seizures are rare in clinical use of HBOT, but have been reported.58 Pressures and duration of HBOT differ between treatment centers, and standardized protocols require further investigation. »

« The secondary benefits of HBOT include reducing inflam- mation, attenuating reperfusion injury, promoting wound healing, and improving circulation. The primary benefits include increased oxygen tension, antimicrobial activity, and blocking HIF activity. Overall, HBOT is a safe and well- tolerated therapy when used under the direction of experi- enced and licensed treatment facilities. Side effects of HBOT are self-limiting and rare due to screening. HBOT has so many potential benefits and modalities for its use. It seems strange that HBOT has failed to gain widespread support. This is likely due to the history of HBOT and public opinion. »


HBOT has many current indications for treatment due to its ability to counter oxygen deficits, promote healing and angiogenesis, fight infection, and control inflammation. Inflammation is the body’s response to all insults and, in some instances, the body loses control over the system. This can lead to chronic disease or play a role in the development of disease. Evidence supporting the utility of HBOT as an anti-inflammatory treatment is growing. HBOT offers the possibility of a new drug class and will require more research to determine its dosing and indications for treating disease. The use of HBOT to treat the secondary injury process that causes damage in acute conditions could prove to be very valuable.56 Technological advances that make HBOT more available promote its potential to fight death and disability. »


Français ( en bref)

La manière dont l’OHB ( Hyperbare)affecte le corps à la suite d’effets primaires et secondaires doit être comprise. Les effets primaires, ou directs, incluent la correction de l’hypoxie en augmentant l’apport en oxygène et la tension, l’activité antimicrobienne et l’atténuation des effets induits par HIF. Les effets secondaires comprennent les conséquences indirectes de l’OHB, telles que la réduction de la formation de ROS, l’augmentation de la capacité de guérison du corps, la vasoconstriction et l’angiogenèse, ainsi que la maîtrise de l’inflammation.

Les pressions thérapeutiques utilisées dans l’OHB sont décrites en termes d’atmosphère de pression. (de 1,5 à 3,0 atm. )

En général, les pressions partielles plus basses sont privilégiées pour éviter les barotraumatismes des poumons, des tympans, des sinus et des dents.

Les crises convulsives dues à la toxicité de l’oxygène sont rares dans l’utilisation clinique de l’OHB mais ont été rapportées.

Les pressions et la durée de OHB diffèrent d’un centre de traitement à l’autre et les protocoles standardisés nécessitent des investigations complémentaires.

Les avantages secondaires de l’OHB comprennent la réduction de l’inflammation, l’atténuation des lésions de reperfusion, la promotion de la cicatrisation des plaies et l’amélioration de la circulation.

Les principaux avantages comprennent l’augmentation de la tension en oxygène, l’activité antimicrobienne et le blocage de l’activité HIF.

Dans l’ensemble, l’OHB est un traitement sûr et bien toléré lorsqu’il est utilisé sous la direction d’établissements de traitement expérimentés et agréés.

Les effets secondaires de l’OHB sont spontanément résolutifs et rares en raison du dépistage. L’OHB présente de nombreux avantages et modalités d’utilisation.

Il semble étrange que l’OHB n’ait pas réussi à obtenir un large soutien.

Cela est probablement dû à l’histoire de l’OHB ( Hyperbare) et à l’opinion publique.

l’OHB ( Hyperbare) a de nombreuses indications actuelles de traitement en raison de sa capacité à lutter contre les déficits en oxygène, à favoriser la guérison et l’angiogenèse, à lutter contre les infections et à contrôler l’inflammation.

L’inflammation est la réponse du corps à toutes les insultes et, dans certains cas, le corps perd le contrôle du système. Cela peut conduire à une maladie chronique ou jouer un rôle dans le développement de la maladie. Les preuves à l’appui de l’utilité de l’OHB en tant que traitement anti-inflammatoire se développent.

l’OHB ( Hyperbare) offre la possibilité d’une nouvelle classe de médicaments et nécessitera plus de recherche pour déterminer sa posologie et ses indications pour le traitement de la maladie.

L’utilisation de l’OHB ( Hyperbare) pour traiter le processus de blessure secondaire causant des dommages dans des conditions aiguës pourrait s’avérer très utile.

Les avancées technologiques qui rendent l’OHB ( Hyperbare) plus disponible renforcent son potentiel de lutte contre la mort et l’invalidité.


Not all text of this one, https://www.ncbi.nlm.nih.gov/pubmed/29804339

But only conclusion : ( if someone wants to translate for us from Hebrew all text please contact me 🙂

could you please pm me? It looks interesting..


Heres the summary from google translate:

Hyperbolic Oxygen – Basic principles and new applications


Hyperbaric oxygen therapy is used as a primary treatment and as a complementary treatment for a wide variety of problems. Which can be classified into two groups of medical parenting: primary pressure treatment (eg The increase in the amount of free oxygen molecules during treatment in a pressure chamber allows for a diffuse force(Diffusion) is greater to the tissue and a significant increase in the amount of oxygen that reaches to the mitochondria in the cell.

The most common indications are related to the use of hyperbolic oxygen to treat wounds that are difficult to heal. With However, in a series of clinical and pre-clinical studies from recent years, it has been shown that the increase amount of oxygen in brain tissue damaged by injury so oxygen delivery with hyperbaric oxygen therapy has a beneficial effect In many physiological aspects: raising neroplasticity, restoring mitochondrial function, and creating blood vessels with improved local and systemic brain and blood vessels, changing the necessary environmental conditions The reduction of neuronal responses, and increased brain metabolism

The beneficial effect is in areas where there is a discrepancy between the anatomical damage And the metabolic functions of brain cells. Studies from recent years show that treatment Hyperbolic oxygen can play a significant role in brain rehabilitation processes in patients after Brain events, patients with neurogenic disorders after head trauma and in some patients With chronic pain syndrome (fibromyalgia). The new studies bring new insights into the Processes of healing and functioning of the brain and develop additional avenues of research.

Claudine Lanoix story and Hbot:

I just connected with Claudine Lanoix I really want to tell her Cp children’s story ( she promised to make her testimonials later so I will post it as well soon)

But she gave me permission to share all I wish about her sons story because as she said I me « I can’t tell you how happy I am that we have connected!! I give you my permission to share what ever I send you….It is my mission in this lifetime to have all children with anoxic or ischemic injury treated in HBOT as soon as possible after the event.  »

And just this article will tell you some part of her children’s story: « On January 5, 2019 Claudine Lanoix was recognized by the International Hyperbaric Association for her role in establishing hyperbaric oxygen as a treatment option providing significant benefits to children with neurological injuries. Claudine accepted the Vanguard award from Dr. Paul Harch at the January meeting of the International Hyperbaric Association. In receiving this award Claudine recognized her journey and the journey of all parents of children with neurological injuries and special needs.

Claudine, a mother of five, whose youngest sons (twins) were born prematurely at 27 weeks, developed Cerebral Palsy. Their journey took them to England, where they received hyperbaric oxygen therapy. Their lives were forever changed. Matthieu stepped from his wheelchair, walking without assistance for the first time. His brother Michel following treatments attained trunk control and was sit up without assistance, opened his hands so that he could feed himself and he began to speak for the first time at the age of 4 years.

Organizing and working with parents groups in Quebec and with the help of Dr Pierre Marois, a McGill Pilot study of 25 children with Spastic Diplegic Cerebral Palsy was conducted. Significant benefits were noted with improvement in Gross Motor Function, Fine Motor Function, reduction in spasticity. Improvements were also noted in speech, sleep and over all cognitive function.

These same findings were duplicated once again in a Multi-centre trial with 111 children in 2001 and validated in a 10 year follow-up published in 2014. The life changes are durable.

Twenty years later, Mathieu attends college with an area of study in Computer Sciences. Working at Best Buy as part of the Geek Squad over the Christmas Holidays, he set up new computers and repaired those that malfunctioned. Michel attends school working as a teacher assistant teaching immigrants English. Both speak French and English. Their changes were permanent. Their lives changed forever by HBOT. »

Hire find her story on YouTube

In order to wait you till she can testimonials by herself 😉


Naw she has hyperbaric center in Canada:

Centre Hyperbare De L’Ile // Island Hyperbaric Centre

website: www.centrehyperbare.ca email: centrehyperbare@bellnet.ca

located at 117 Boul Cardinal Leger, in Pincourt, Quebec, Canada J7W 7A8 phone: 514-453-7978 // 1-866-677-7978

contact :Claudine Lanoix or Tiffany Nadeau – Thomas Fox

It is her mission : in this lifetime to have all children with anoxic or ischemic injury treated in HBOT as soon as possible after the event. 🙂

This one video her testimonials back in 2009:


And this one ( helping naw others children’s)





The article presents a comparative analysis of treatment of 76 pregnant women with diabetes mellitus type I, divided into two groups: basic and control. In the control group carried out conventional medical therapy, and patients of the main group along with those received courses of hyperbaric oxygenation. Evaluating the effectiveness of therapy based on the data of carbohydrate metabolism, glycated hemoglobin, Doppler and cardiotocography before treatment and after its completion. Shown that the use of hyperbaric oxygenation in complex treatment of pregnant women with diabetes mellitus type I reduces the complications of pregnancy, improve perinatal outcomes.

Yes in Russia we have studies with Hbot 1,3-1,5 ata for pregnant women’s with diabetes type 1 :


I will translate only final conclusion ok?

Material and research methods:

We evaluated the results of therapy in 76 pregnant women suffering from diabetes I, with single pregnancy. The contingent of the subjects was divided into two groups: the main and the control group. The main group consisted of 32 (42.1%) patients who received a comprehensive treatment of diabetes using HBO. All pregnant women admitted to hospital were given the standard medical treatment for diabetes mellitus I, which included insulin therapy. The use of another drug therapy depended on the complications of the course of pregnancy.

At the same time, pregnant women of the main group included in the complex of therapy sessions of HBO, which consisted in exposing the body to excessive atmospheric pressure of 1.3-1.5 atm. in baro-camera conditions. A single-use OKA-MT system (Russia) was used, equipped with an air conditioner of 54–58 A and designed for conducting sessions under conditions of elevated oxygen pressure. Mode of operation – one excess atmosphere. HBO courses included 5–7 daily sessions lasting 40 minutes each. Pregnant women received 3 courses of HBO. The first course was carried out in 6-8 weeks., The second – in 16-18 weeks. and the third in 22–24 weeks. of pregnancy.

The choice of these terms of pregnancy was determined by the most important periods of formation of the uteroplacental region. Since the earliest period of therapeutic effect on the blood flow in the uteroplacental region in order to correct its disorders can be considered 7–8 weeks. and 16-18 weeks. gestation, until the end of the first and second waves of cytotrophoblast invasion. When prescribing HBO sessions for pregnant women, absolute and relative contraindications were taken into account.

The treatment of the studied patients of both groups resulted in a decrease in the glycemia level. At the same time, in cases of applying HBO this decrease was more pronounced. If, prior to the courses of HBO, the glycemia level in the main group was on average 7.3 ± 1.3 mmol / l, after receiving the full course of HBO – 5.3 ± 0.7 mmol / l. In the same patients who received insulin therapy without HBO, glycemia indices did not differ significantly during the entire pregnancy and averaged 7.0 ± 1.3 mmol / l.

The criteria for the compensation of diabetes is not only noreglycemia, but also the normalization of the level of glycated hemoglobin.

On the background of treatment with HBO, there was a significant decrease in this indicator: from 7.1 ± 1.2 to 5.6 ± 0.7%. After conducting HBO courses in the studied patients, a significant improvement in Doppler data was observed. Indicators of uterine and fetoplacental blood flow increased by 32%, while in patients receiving conventional therapy, only by 17%. With the use of HBO, cardiotocography parameters improved: the amplitude of oscillations increased, the number of accelerations increased, and decelerations disappeared. The condition of all newborns was assessed on the Apgar scale.

In newborns from mothers who received traditional therapy, the Apgar score was in the first minute of life 7.2 ± 1.4 points, in the fifth minute 7.8 ± 1.2 points; in newborns from mothers who received HBO courses, in the first minute of life 7.6 ± 0.6 points, in the fifth minute 8.4 ± 0.7 points. Thus, both in the first minute and in the fifth minute, the average Apgar score in the main group was significantly higher compared to the control group. The frequency of neonatal asphyxia in the main group (1.3%) was significantly lower than in the control group (5.3%). The number of children born with signs of diabetic fetopathy in the main group (3.1%) was significantly lower than in the control group (9.1%).

T V Kuzenkova

Peoples, Friendship University of Russia

Department of Obstetrics and Gynecology with the course of Perenathology

I A Litvinenko

Peoples, Friendship University of Russia

Email: pishite2003@bk.ru

Department of Obstetrics and Gynecology with the course of Perenathology

A A Lukaev

Peoples, Friendship University of Russia

Email: aleksei_lukaev@mail.ru

Department of Obstetrics and Gynecology with the course of Perenathology

T V Zlatovratskaya

Clinical Hospital № 29

G S Bogdanova

Clinical Hospital № 29

T A Starceva

Clinical Hospital № 29

N T Tabatadze

Clinical Hospital № 29



Cerebral ischemia (CI) is damage to the brain tissue that occurs as a result of prolonged insufficient oxygen supply. CI occupies one of the most important places in terms of incidence and significance in the morbidity structure, making up 60-80% of all diseases of early childhood and occupying the 1st place in the structure of children’s disability. She is assigned the main role in the formation of the breakdown of the adaptive capacity of the newborn. Pathologically, this pathology is manifested in persistent hypoxia of brain tissue due to spasm of small blood vessels, a decrease in blood flow to the brain, and metabolic disorders in nerve cells [6, 12].

One of the pathogenetically substantiated non-drug methods of treating patients with this pathology is general magnetic therapy and hyperbaric oxygenation (HBO). Under our supervision there were 150 children of the first month of life with cerebral ischemia of moderate severity, hypertensive-hydrocephalic syndrome, who were hospitalized at MMU DGKB № 1 them. N.N. Ivanova G. O. Samara in 2009-2010 : (I can’t translate all study sorry)

So: Just part for 3 d group: Hbot+ magnetic therapy

Children III, the main group received a standard for this pathology drug therapy, a course of general magnetic therapy, and after it ended, they conducted a course of hyperbaric oxygenation (HBO). HBO was performed in the physiotherapy department of the MUH DGKB № 1 them. N.N. Ivanova in accordance with the requirements of ONTP 24-86 MVD, SNiP 11-69-78, GOST 12.2.052-81, OMU 42-21-26-88, GOST R 51316-99. Used pressure chamber BLKS – 3-01. The equipment is certified by the relevant authorities and approved by the Ministry of Health and Social Development of the Russian Federation and the Gosgortechnadzor of Russia to conduct HBO sessions.

Before the first session of HBO therapy, the parents of the children were introduced to the essence of the upcoming treatment in the pressure chamber, the requirements for the child’s clothes. When placed in the pressure chamber, patients were dressed in cotton underwear, and a cotton cap was put on their heads. For vacation sessions of hyperbaric oxygenation to children in the first months of life, we have developed a device in the form of a special L-shaped mattress. It is made of technical foam rubber, impregnated with flame retardant. The mattress is located in the pressure chamber, closing the input panel, but thus not preventing the child from moving [8].

Hyperbaric oxygenation was performed for children in an atmosphere of pure oxygen, carrying out a preliminary leaching regime, the pressure was raised to 0.2-0.4 ati, ( it’s means 1,2-1,4 ata total pressure) at a rate of 0.1 ati (1,1 ata) for 2 minutes, saturation for 15-20 minutes, decompression at 0.1 (1,1ata) at 1 minute . The duration of compression and decompression was 4 minutes each. The total duration of the session is 30 minutes. The course of treatment was 8-10 procedures carried out daily [3].

In children who received complex treatment in combination with HBO and general magnetic therapy, the most positive dynamics of NSDG parameters were observed. In 65.4% of patients in this group, a decrease in lateral ventricular indices was noted, in 72.1% a decrease in bone-brain diastasis, in 74.3% a decrease in the size of the interhemispheric fissure (p <0.05) compared with group 1 . In 23% of the observed children, the presence of periventricular leukomalacia was noted. She underwent a reverse development during treatment in patients in all three groups. However, we observed a significant decrease in the number of patients with such an ultrasound picture of the brain tissue only in children who received physiotherapy treatment.

Patients of group II compared in 22.5%, III, main group, in 47% (p <0.05). One third of children with cerebral ischemia under our supervision observed the presence of a pseudocyst or a symptom of « Swiss cheese. » Against the background of the therapy, statistically significant changes in the form of complete resorption of these formations or reduction of their size were noted only in the II and III groups – in 32.2% and 33.1%, respectively.

After treatment, all patients showed a positive trend in EEG indices. However, significant changes were noted only in children of groups II and III. So, the restoration of the picture of the zonal pattern of the electroencephalogram according to the age norm was observed in 29.4% of patients of group II and 36.5% of group III (p <0.05). Significant negative samples for hypercapnia and photostimulation were observed only in children of group III compared with data in children of groups I and II (p <0.05).

Thus, the proposed methods of non-pharmacological treatment of cerebral ischemia in children in the neonatal period can significantly improve the effectiveness of standard therapy for this pathology.


Пименов Ю.С., д.м.н., профессор, зав. кафедрой внутренних болезней НОУ ВПО «Самарский медицинский институт «РЕАВИЗ», г. Самара;

Богданова Л.П., д.м.н., профессор кафедры реабилитации и сестринского дела НОУ ВПО «Самарский медицинский институт «РЕАВИЗ», г. Самара.

L’Institut national d’excellence en santé et en services sociaux (INESSS) s’est vu confier le mandat d’évaluer la valeur thérapeutique de l’oxygénothérapie hyperbare dans la prise en charge de la paralysie cérébrale.

Svpl toutes mes contacts qui utilisent Hyperbare et qui parle français répondre cet questionnaire ( en espérant que ça va donner ses résultats pour promouvoir loi sur Hyperbare à Canada !)


C’est le temps de faire valoir notre expérience, n’hésitez pas à participer et à partager 🙂

L’Institut national d’excellence en santé et en services sociaux (INESSS) s’est vu confier le mandat d’évaluer la valeur thérapeutique de l’oxygénothérapie hyperbare dans la prise en charge de la paralysie cérébrale.

Pour ce projet, l’INESSS est à la recherche de parents et de proches aidants d’enfants atteints de la paralysie cérébrale et de jeunes adultes avec la paralysie cérébrale de 18 à 25 ans afin de mieux comprendre l’expérience de soins, leurs besoins non comblés et leur perspective face à l’oxygénothérapie hyperbare.


HBOT efficacy in brain repair

The recent evidence for HBOT efficacy in brain repair and the new understanding of brain energy management and response to damage opens new therapeutically fields that will be further investigated in the upcoming years.

Very interesting article ( from pediatric doctor who had herself TBI and did Hyperbare in Israel)



Video :

Video is in English do listen it: (it’s explain really well about brain and why hbot can help neurological conditions : it’s started with strokes than TBI than fibromyalgia etc….)


« Clinical studies published in the last 3 years present convincing evidences that hyperbaric oxygen therapy (HBOT) can be the coveted neurotherapeutic method for brain repair. HBOT is a treatment in which oxygen-enriched air (up to 100%) is administrated to patients in a chamber where the pressure is elevated above 1ATA (one atmosphere absolute, which is the ambient atmospheric pressure). It is now realized, that the combined action of hyperoxia and hyperbaric pressure, leads to significant improvement in tissue oxygenation while targeting both oxygen and pressure sensitive genes, resulting in improved mitochondrial metabolism with anti-apoptotic and anti-inflammatory effects. In addition, the oxygen fluctuation generated by HBOT stimulates stem cells proliferation, HIF increased (The hyperoxide paradox) and brain angiogenesis. The lecture will introduce the current understanding of the multi-faceted role of HBOT in neurotherapeutics and the new understanding of brain energy management and response to trauma in general  »

Source :http://pracdemia.haifa.ac.il/index.php/en/23-kit-cat/video/161-hyperbaric-oxygen-therapy-basics-and-neurological-applications-the-case-of-childhood-trauma-shai-efrati

Study which compares different pressures for CP

( I will say study wich makes people argue)….

Will be 1,3 ata without oxygen enough for CP?

Or 1,5ata with 100% oxygen is better ???

This is the question ! Is only one study enoth to answer it? I don’t know….

Are all children’s with CP need same protocol ?



here the study comparing 1,3 ata air

With 1,5ata

With 1,75 ata

( it was published by Dr Arun Mukerjee India):

Please see his conclusions :

So in fact conclusion is that all Hbot groups give improvements with no significant differences …. and that more study neded….

An this study was made in India with help of dr Marois (Canada)…..

In fact, this study compares the use of various hyperbaric pressures with the use of (ambient) air alone or oxygen-enrichment in the treatment of children with Cerebral Palsy (CP). The study shows that low pressure ambient air hyperbaric therapy (1.3 atmospheres-ATA) is also effective not only high pressure 100% oxygen (1.5 or 1.75 ATA) in the treatment of CP.

The children were studied by Dr. Arun Mukherjee, director of the UDAAN Disabled Children’s Center, a non-profit organization, recognized and aided by the Indian Ministry of Social Justice & Empowerment.

This landmark study, co-authored with Dr. Pierre Marois (McGill University in Montreal, Canada), further develops the 1999 ground-breaking McGill study (Lancet, February 2001) by expanding the number of subjects and by implementing an accurate placebo-control testing method. Subjects with a functional diagnosis of spastic diplegia cerebral palsy received one of four hyperbaric options, in addition to standard therapies:

1) the placebo therapy (20 subjects);

2) hyperbaric therapy at 1.3 ATA breathing ambient air under pressure (36 subjects);

3) hyperbaric therapy breathing 100% oxygen at 1.5 ATA (32 subjects); and

4 ) 1.75 ATA with 100% oxygen (58). All subjects were reevaluated at six months after conclusion of therapy to negate any traces of the placebo effect.

The study showed significant improvements FOR ALL THREE GROUPS receiving therapy hbot !!!!!(the placebo group showed little or no improvement).

They mentioned in study that 1,3 ata could be an option for parents who can’t afford 1,5 ata to get far degree of improuvments (read also please paragraph about chambers problems…)

They also mentioned in study:

…..”it is possible that the cp child with greater motor dysfunction will be slightly better with regular hbot 1,5 ata 100% oxygen”

So we need more studies to be shure which pressure is better for cp … in meantime wile we have no such studies I will be happy if parents with CP child trying any law neurological pressure …( better with Hbot doctor guidence ) so any law pressure 1,3 or 1,5 or 1,75 ….

Read all study… in details and do best you can for your children’s 😉

Bottom line ( pressure) is nobody really knows yet which is the best protocol.

Weakness if this study: absence of spect scans for all 3 groups with Hbot treatments before treatment and after.

As dr Efrati said in his research: « Unfortunately, in many – if not most – clinical studies done with hyperbaric oxygen on brain-in- jured patients, including those with cerebral palsy, the stunned areas have not been assessed by imaging. The anatomical/physiological imaging should be incorpor- ated as an essential part of the basic evaluation of every candidate for hyperbaric oxygen therapy. »

This study in India was done without any spect or MRI ….


But what firsthand we have to think when we talk about brain injury and CP: obviously more studies are needed!

And i think parents can help in someway to push for Hbot if we contact enough gouvernements / researchers/ media’s we need to take Hbot in the “light “ in order that general population knows about and that Hbot can help neurological conditions we need work all together not in separate camps… 😉 and doctors have to stop taking -us – parents like we are absolutely stupid 😉

( unfortunately we have some doctors which thinks we can only listen their orders) we are also need to study ( parents) and we can also bring some informations to doctors if they wants to listen us 😉

Clearly, large-scale, well-controlled, pressure dose- response studies are required to determine the optimal HBO2 therapy protocol for different conditions. Until such information is available, any treatment involving change in the environmental pressure should be con- sidered as a dose-comparison rather than a sham-control study. Moreover, since at a young age, brain protection is stronger (reflected by high ROS levels associated with CP) and neuroplasticity is more potent, it is reasonable to expect that optimal efficacy will be achieved by lower tissue oxygenation. Along such line of reasoning, the previously described trials used 2.0 atm abs for post- stroke patients and 1.5 atm abs for patient with mTBI with an intact macrovascular bed [23,24]. Due to the high diversity in the manifestation of cerebral palsy and in its severity, future efforts should also be directed towards a personalized dose-response curve. For example, it is likely that higher tissue oxygenation will be the practice of choice for children with a high expression of ApoE4, which is an inhibitor of mitochondrial respiration.”

And : “One must bear in mind that children with CP suffer neurological deficiency since birth, so it will take time for the brain repair to become clinically apparent. For example, it is not reasonable to administer 20 daily HBO2 sessions to children with pervasive developmental disorders (PDD) and expect to see significant clinical progress within a time frame of less than a month [25].

On the other hand, it is important to perform fre- quent metabolic/physiological evaluations, which may provide valuable information for adjusting the dose- response curve. More studies are needed to determine the minimal effective dosage and the treatment duration for specific brain injuries. Non-invasive, in-chamber measurements that are currently being developed, speci- fically EEG and DTI, may shed some light on this important question.”

And: “the optimal candidate for hyperbaric oxygen is a patient with unrecovered brain injury where tissue hypoxia is the limiting factor for the regeneration processes. In this patient, HBO2 may induce neuroplasticity in the stunned regions where there is a brain anatomy/physiology (e.g., SPECT/CT) mismatch [23,”