Application of intermittent hypoxia-hyperoxia therapy in clinical practice: perspectives for use in neurorehabilitation (literature review)

Introduction. The article focuses on exploring the possibilities of intermittent hypoxia-hyperoxia therapy (IHHT) as an effective and safe method for neurorehabilitation of patients who have suffered severe brain injuries and remain in a state of chronic critical illness. Literature review of scientific publications indicates that IHHT can activate important adaptive mechanisms, modulate antioxidant pathways, improve mitochondrial function, and stimulate neuroplasticity.

The objective was to review current data on the mechanisms of intermittent hypoxia-hyperoxia therapy and evaluate its potential as a treatment and rehabilitation strategy for patients with chronic critical illness following severe cerebrovascular events in neurological intensive care units.

Materials and Methods. We conducted a literature review using databases such as Web of Science, Scopus, PubMed, RSCI, and eLibrary. The analysis included 43 sources presenting up-to-date clinical and experimental approaches to the use of IHHT, its underlying mechanisms, and efficacy assessment. In addition, the article also includes the authors’ ICU experience with IHHT in chronically critically ill patients following severe cerebral catastrophes.

Results. IHHT has been shown to activate several key adaptive mechanisms, including the expression of HIF-1α (Hypoxia-inducible factor 1-alpha) and HIF-2α (Hypoxia-inducible factor 2-alpha), modulation of antioxidant pathways involving Nrf2 (Nuclear factor erythroid 2-related factor 2), improvement of mitochondrial function, stimulation of angiogenesis and neuroplasticity. Positive clinical effects are observed when therapy parameters are carefully individualized and safety is closely monitored. The method shows promising potential for integration into personalized therapeutic and rehabilitation protocols in intensive care settings.

Conclusion. Intermittent hypoxia-hyperoxia therapy represents a promising adjunctive approach for ICU patients with sequelae of severe cerebral catastrophes, enhancing endogenous recovery mechanisms. In the future, multicenter clinical studies are required to standardize the method, refine indications and contraindications, and develop clinical protocols for its use in intensive care.

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