A Breath of Hope? Ethical and Clinical Considerations of Hyperbaric Oxygen Therapy in Pediatric Anoxic Brain Injury

Case Diagnosis: Families often seek experimental therapies like hyperbaric oxygen therapy (HBOT) for brain injuries despite uncertain benefits. This case examines the ethical challenges of HBOT use in pediatric hypoxic brain injury.

Case Description or Program Description: A 2-year-old boy suffered a non-fatal drowning, per reports he submerged for nearly an hour before ROSC. In a Canadian Hospital, investigations confirmed severe hypoxic brain injury and diffuse encephalopathy. He remained minimally conscious, opening his eyes without purposeful movement. Despite a poor prognosis, the family insisted on a tracheostomy, gastrostomy, and HBOT, prompting transfer to Ochsner Medical Center (OMC). There, the team balanced sedation and neuro-stimulation for autonomic instability. Post-discharge, the family continued HBOT, paying out-of-pocket at a private for-profit clinic.

Setting: Initial care was in Canada before transfer to OMC for HBOT. Outpatient HBOT followed, with plans for further experimental therapies in Mexico.

Assessment/Results: The family perceived improvements following HBOT, but the patient remained minimally conscious with limited eye tracking, fully dependent on care, and non-responsive to name and commands. Persistent left-sided hypertonia, and intact deep tendon reflexes without motor gains were noted. The family is now focused on home therapies, medication weaning, and seeking additional experimental treatments.

Discussion (relevance): This case highlights an ethical dilemma in pediatric rehabilitation: navigating family expectations when medical teams deem further interventions unlikely to improve function. While patient autonomy is key, clinicians must ensure treatments offer real benefits without harm. Although some studies suggest HBOT may aid recovery in traumatic brain injury, its efficacy in hypoxic-ischemic encephalopathy remains unproven. The risk of false hope, resource strain, and deviation from evidence-based care complicates ethical decision-making. Transparent communication is crucial when families persist with interventions considered futile, ensuring hope remains balanced with realistic expectations.

Conclusions: Pediatric rehabilitation specialists must balance family-driven hope with medical realities, ensuring discussions on experimental treatments remain ethical, transparent, and patient-centered.