Consensus Guidelines for Hyperbaric Oxygen Therapy in Traumatic Brain Injury: A Delphi Study from India

Abstract Background: Hyperbaric oxygen therapy (HBOT) has shown use in the treatment of traumatic brain injury (TBI). Clear, context-specific guidelines are absent, particularly in resource-limited settings like India. There are over 1.6 million TBIs annually in India. There is growing interest in HBOT. This study aimed to develop the first India-specific consensus-based guidelines for its clinical use in TBI. Methods: A modified Delphi technique was employed, following the Conducting and Reporting Delphi Studies checklist, engaging expert members of the Hyperbaric Society of India across four structured rounds. Participants reviewed literature, rated proposed statements and refined items through both anonymous and open discussions over four rounds. Results: From 238 initial responses, the panel distilled 42 items, ultimately reaching consensus on 15 core guideline statements. These address critical gaps left by global recommendations, including treatment pressure, duration, timing and patient selection. Results highlight the feasibility and value of HBOT across TBI severity levels, with demonstrated benefits in cognition, intracranial pressure reduction and survival. Conclusion: This initiative represents a vital step towards standardised HBOT use for TBI in India, providing actionable guidance for clinicians and supporting further integration of this evidence-based modality into neurorehabilitation practice.