2026 · Frontiers in Neurology
The awakening effect of hyperbaric oxygen therapy combined with systematic auditory stimulation in comatose patients with craniocerebral injury and its influence on serum biomarkers.
Background Severe traumatic brain injury (sTBI) often results in prolonged coma and significant long-term disability. Evidence-based, widely accessible approaches to accelerate recovery of consciousness remain limited. This study evaluated whether adding a combined regimen of hyperbaric oxygen therapy (HBOT) and systematic auditory stimulation (SAS) to standard neurosurgical care improves recovery of consciousness and short-term outcomes in comatose patients with sTBI. Methods In this prospective randomized controlled trial, 89 comatose patients with sTBI [Glasgow Coma Scale (GCS) < 8] were randomized to standard neurosurgical care (control, n = 44) or standard care in addition to HBOT and SAS (HBOT+SAS, n = 45). HBOT was delivered at a pressure of 2.0 atmospheres absolute (ATA) for 60 min/session, five sessions per week for 4 weeks. SAS consisted of structured family-delivered storytelling and music sessions three times daily following a predefined schedule. The primary outcome was the change in the Full Outline of UnResponsiveness (FOUR) score from baseline to Day 28. Secondary outcomes included the GCS and Coma Recovery Scale-Revised (CRS-R) scores, the Glasgow Outcome Scale (GOS) score at 3 months, and serum biomarkers [such as S100B, neuron-specific enolase (NSE), and brain-derived neurotrophic factor (BDNF)]; care-related satisfaction was analyzed as an exploratory outcome. Secondary endpoints were interpreted using a prespecified Bonferroni-adjusted threshold ( p < 0.01). Results Compared to the control group, the HBOT+SAS group demonstrated greater improvement in measures of consciousness at Day 28 (FOUR: 12.1 ± 2.4 vs. 9.3 ± 2.1; GCS: 11.3 ± 2.2 vs. 9.1 ± 1.9; CRS-R: 11.8 ± 2.3 vs. 8.1 ± 2.0; all p < 0.001). At 3 months, the functional outcome was higher in the HBOT+SAS group (GOS: 4.3 ± 0.5 vs. 3.6 ± 0.6, p < 0.001). Biomarker patterns indicated a reduction in neuronal injury and an enhancement in neurotrophic activity. Specifically, levels of S100B and NSE were lower in the HBOT+SAS group (both p < 0.001), and BDNF was higher ( p = 0.003) in this group. No serious adverse events related to the intervention were reported. Satisfaction outcomes favored HBOT+SAS (88.89% vs. 59.09%, p = 0.005) and were interpreted as exploratory due to the unblinded design of the study. Conclusion The addition of HBOT+SAS to standard care was associated with improved recovery of consciousness and better 3-month functional outcomes in comatose patients with sTBI, supported by consistent findings from clinical scales and serum biomarkers. However, since the trial did not include HBOT-only or SAS-only comparator arms, the findings support the effectiveness of the combined regimen compared to standard care but do not determine whether HBOT and SAS have a synergistic effect.