Oxygen Therapy for Intracranial Hemorrhage

AIMS: Intracranial hemorrhage (ICH) is a severe cerebrovascular disease with a high mortality rate that impairs patient well-being and quality of life. Oxygen therapies, including hyperbaric hyperoxia (HBO) and normobaric hyperoxia (NBO), have attracted widespread attention as potential adjuvant treatments because of their neuroprotective effects. This review aimed to summarize the current literature addressing the neuroprotective mechanisms of oxygen therapy in ICH, as well as its effectiveness and safety in patients with ICH. METHODS: We systematically searched multiple literature databases including PubMed, Embase, and Cochrane for publications containing specified keywords and published prior to November 2025. The references were thoroughly reviewed to identify other articles that may have been missed in our search. RESULTS: A total of 38 articles were included in this study. Among them, 20 mainly studied the mechanism of oxygen therapy after ICH, eight mainly investigated the effects of oxygen therapy in patients with ICH, and 10 primarily analyzed the safety of oxygen therapy in patients with ICH. The experimental results showed that the treatment mechanism of HBO mainly involves reducing cerebral vasospasm, promoting angiogenesis, inhibiting inflammatory responses, and improving aerobic energy metabolism, whereas NBO mainly protects the blood-brain barrier (BBB), reduces cerebral edema and hemispheric swelling, mitigates acute inflammation, inhibits oxidative stress and neuronal cell death, and enhances aerobic metabolism. Clinical trials have shown that oxygen therapy can improve neurological function recovery and long-term prognosis in patients with ICH, as reflected by better scores in some indicators and lower mortality rates; however, oxygen therapy also has controversial and potential risks. Excessive oxygen supply may lead to adverse reactions, and hyperoxia may negatively impact patients with ICH. An appropriate treatment plan should be formulated for the clinical application of oxygen therapy. CONCLUSION: Oxygen therapy shows potential in ICH treatment through multiple mechanisms; however, its safety and optimal regimen require further large-scale randomized controlled trials to balance the benefits and risks and optimize its application strategies.