Objective:

To evaluate the effectiveness of combined hyperbaric oxygen therapy (HBOT) and systematic auditory stimulation (SAS) in improving recovery of consciousness and short-term outcomes in comatose patients with severe traumatic brain injury (sTBI), addressing a significant gap in current treatment options.

Key Findings:

• HBOT+SAS group showed greater improvement in consciousness measures at Day 28 (FOUR: 12.1 vs. 9.3; GCS: 11.3 vs. 9.1; CRS-R: 11.8 vs. 8.1; all p < 0.001), indicating significant clinical relevance.
• At 3 months, functional outcomes were better in the HBOT+SAS group (GOS: 4.3 vs. 3.6, p < 0.001).
• Biomarkers indicated reduced neuronal injury (lower S100B and NSE levels) and enhanced neurotrophic activity (higher BDNF levels) in the HBOT+SAS group, suggesting a physiological basis for the observed clinical improvements.
• Satisfaction outcomes favored HBOT+SAS (88.89% vs. 59.09%, p = 0.005), though this was influenced by the unblinded design.

Interpretation:

The addition of HBOT and SAS to standard care significantly improved consciousness recovery and functional outcomes in comatose patients with sTBI, as supported by clinical scales and serum biomarkers, highlighting the need for further exploration in clinical practice.

Limitations:

• The study did not include HBOT-only or SAS-only comparator arms, limiting the ability to assess the individual contributions of each intervention.
• The unblinded design may introduce bias in satisfaction outcomes, potentially affecting the reliability of these results.

Conclusion:

The combined regimen of HBOT and SAS appears effective in enhancing recovery of consciousness and functional outcomes in patients with sTBI, warranting further investigation into their synergistic effects and potential implementation in clinical settings.