AI-Assisted Precision Hyperbaric Oxygen Therapy Based on Dynamic BIS-EEG Feedback for Patients With Disorders of Consciousness

This prospective randomized controlled clinical study will evaluate whether an artificial intelligence-assisted precision hyperbaric oxygen therapy strategy improves clinical outcomes compared with conventional hyperbaric oxygen therapy in patients with disorders of consciousness.

Patients with disorders of consciousness, including vegetative state/unresponsive wakefulness syndrome and minimally conscious state, will receive standardized hyperbaric oxygen therapy. Multimodal clinical data will be collected, including demographic characteristics, disease etiology, disease duration, baseline consciousness assessment, neuroimaging findings, physiological parameters, BIS-EEG signals, and HBOT treatment parameters.

Dynamic BIS-EEG monitoring will be conducted throughout the entire HBOT session. Brain functional responses will be evaluated during the following phases: pre-treatment baseline, compression, hyperbaric oxygen exposure, air-break interval, repeated oxygen exposure, decompression, and post-treatment recovery.

The artificial intelligence system will integrate multimodal information using machine learning approaches to identify predictive biomarkers of neurological recovery and provide individualized decision support regarding HBOT treatment parameters, including treatment pressure, oxygen exposure duration, air-break strategy, treatment frequency, and treatment course.

The effectiveness of the AI-assisted decision support system will be evaluated by comparing predicted treatment responses with clinical outcomes. Clinical outcomes will include changes in Coma Recovery Scale-Revised (CRS-R) scores, consciousness state transitions, cognitive and functional recovery, and adverse events associated with HBOT.

This study is expected to provide an objective and personalized approach for optimizing HBOT management in patients with disorders of consciousness.

• AI-Assisted Personalized Hyperbaric Oxygen Therapy (Other): Participants will receive hyperbaric oxygen therapy optimized by an artificial intelligence-assisted clinical decision support system. The system integrates dynamic BIS-EEG brain functional feedback, clinical characteristics, neuroimaging findings, physiological parameters, and previous treatment responses to provide individualized recommendations for hyperbaric oxygen therapy parameters, including treatment pressure, oxygen exposure duration, air-break strategy, treatment frequency, and treatment course. Final treatment decisions will be made by qualified physicians.
• Conventional Hyperbaric Oxygen Therapy (Other): Participants will receive conventional hyperbaric oxygen therapy according to standard clinical protocols determined by treating physicians. Treatment parameters will be selected based on routine clinical practice without artificial intelligence-assisted recommendations.

Primary outcomes

• Change From Baseline in Coma Recovery Scale-Revised (CRS-R) Total Score at Week 12 [Baseline and 12 weeks after initiation of hyperbaric oxygen therapy]: The Coma Recovery Scale-Revised (CRS-R) will be used to assess the level of consciousness. The CRS-R total score ranges from 0 to 23, with higher scores indicating better neurobehavioral function and a higher level of consciousness. The change in CRS-R total score from baseline to Week 12 will be calculated for each participant and compared between the AI-assisted precision hyperbaric oxygen therapy group and the conventional hyperbaric oxygen therapy group.

Secondary outcomes

• Change From Baseline in Glasgow Coma Scale (GCS) Total Score at Week 12 [Baseline and 12 weeks after initiation of hyperbaric oxygen therapy]: The Glasgow Coma Scale (GCS) will be used to assess neurological responsiveness. The total score ranges from 3 to 15, with higher scores indicating better neurological responsiveness. Change from baseline to Week 12 will be compared between the AI-assisted precision hyperbaric oxygen therapy group and the conventional hyperbaric oxygen therapy group.
• Number of Participants With Hyperbaric Oxygen Therapy-Related Adverse Events [From the first hyperbaric oxygen therapy session through 7 days after the final treatment session]: The number and proportion of participants experiencing adverse events considered related to hyperbaric oxygen therapy will be recorded and compared between groups. Events of interest include middle-ear or sinus barotrauma, oxygen toxicity, seizures, pulmonary symptoms, hemodynamic instability, and other clinically significant treatment-related adverse events.

Other outcomes

• Discrimination Performance of the AI Model for Predicting Improvement in Consciousness State [Prediction at baseline and during treatment for clinical outcome assessed at Week 12]: The predictive performance of the artificial intelligence model will be evaluated for predicting improvement to a higher consciousness state at Week 12. Discrimination will be assessed using the area under the receiver operating characteristic curve (AUROC). An AUROC of 0.5 indicates no discrimination, whereas values closer to 1.0 indicate better discrimination.

Sex: All, ages: 18 Years to 80 Years

Inclusion Criteria:

1. Adults aged 18 years or older.
2. Diagnosis of disorders of consciousness, including vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS).
3. Disease duration of at least 28 days after the onset of brain injury.
4. Stable medical condition suitable for hyperbaric oxygen therapy.
5. Baseline consciousness assessment available using the Coma Recovery Scale-Revised (CRS-R).
6. Ability to undergo standardized hyperbaric oxygen therapy sessions and complete clinical follow-up.
7. Written informed consent obtained from the legally authorized representative.

Exclusion Criteria:

1. Contraindications to hyperbaric oxygen therapy, including untreated pneumothorax or other conditions considered unsafe for HBOT.
2. Severe cardiovascular, respiratory, or systemic instability.
3. Uncontrolled epilepsy or frequent seizures affecting assessment.
4. Severe infection or metabolic disorders that may influence consciousness assessment.
5. Previous participation in another interventional clinical trial that may affect neurological outcomes.
6. Incomplete baseline clinical data or inability to complete follow-up assessments.