A 60-year-old man from Inner Mongolia sustained multiple injuries after being hit by a cow on a pasture, resulting in immediate loss of consciousness, severe brain contusion, and multiple rib fractures. Despite two weeks of tracheal intubation and mechanical ventilation at a local hospital, the patient remained unconscious and dependent on the ventilator, with a critical condition.
For further treatment, he was transferred to our intensive care unit (ICU). Upon admission, he presented with high fever, severe pneumonia, and excessive sputum. Following gene detection of sputum samples, we implemented a comprehensive treatment plan including precise adjustment of anti-infective medications, bronchoscopic sputum aspiration, and optimized ventilation support. After 10 days of treatment, the patient was successfully weaned from the ventilator.
Subsequent hyperbaric oxygen therapy (HBOT) led to remarkable neurological recovery:
After 5 sessions of HBOT: The patient's consciousness improved significantly.
After 10 sessions: His right limb could be lifted voluntarily.
After 25 sessions: He regained full consciousness and regained voluntary movement in all four limbs.
Currently, the patient is in stable condition and has been transferred back to the local hospital for continued rehabilitation.
1. Severe Infection and Respiratory Support
For severe pneumonia, precise medication administration following pathogen identification via gene detection, combined with bronchoscopic sputum aspiration and optimized ventilation support, was the key to successful ventilator weaning, laying the foundation for subsequent neurological rehabilitation.
2. Role of Hyperbaric Oxygen Therapy (HBOT)
HBOT improves neurological outcomes by elevating partial pressure of oxygen, alleviating cerebral hypoxia, reducing brain edema, and promoting neural cell repair. It serves as a critical rehabilitation intervention for post-traumatic brain contusion with coma and neurological dysfunction. This case clearly demonstrates a dose-response relationship: greater recovery of neurological function correlates with increased numbers of HBOT sessions.
III. Clinical Significance
This case embodies the stepwise and individualized principles of severe trauma care: stabilizing vital signs and controlling infection and respiratory failure first, followed by promoting neurological recovery through rehabilitation modalities such as hyperbaric oxygen therapy. It provides a successful, replicable model for the management of patients with severe brain contusion complicated by respiratory failure.