Introduction Divers often increase their fraction of inspired oxygen (FiO2) to decrease their risk of decompression sickness. However, breathing concentrated oxygen can cause hyperoxia, and central nervous system oxygen toxicity (CNS-OT). This study aims to review the literature describing hyperoxic ventilation’s effect on the electroencephalogram (EEG), thus exploring the potential for real-time detection of impending CNS-OT seizure.

Methods We searched Medline, Embase, Scopus, and Web of Science for articles that reported EEG measures accompanying hyperoxic ventilation (FiO2 = 1.0) in healthy participants. We included peer-reviewed journal articles, books, and government reports with no language or date restrictions. Randomised controlled trials and cross-over studies were included; case reports were excluded. We used the Newcastle-Ottawa scale to evaluate evidence quality.

Results Our search strategy returned 1025 unique abstracts; we analysed the full text of 40 articles; 22 articles (16 studies) were included for review. Study cohorts were typically small, and comprised of male non-divers. We discovered a variety of EEG analysis methods: studies performed spectral analysis (n = 12), the analysis of sensory-evoked potentials (n = 4), connectivity/complexity analysis (n = 3), source localization (n = 1), and expert qualitative analyses (n = 4). Studies of severe exposures (long duration at hyperbaric pressure) typically reported qualitative measures, and studies of mild exposures typically reported quantitative measures.

Conclusions There is a need for a large randomised controlled trial (RCT) reporting quantitative measures to better understand hyperoxic ventilation’s effect on EEG, thus enabling the development of real-time monitoring of CNS-OT risk.

The authors have declared no competing interest.

This work was supported by funding from the Office of Naval Research of The United States Navy (N00014-23-1-2467).

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