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HBO Nuggets of the Week
A forum to discuss interesting aspects of hyperbaric medicine.
Tuesday, June 11, 2013
HBO Nugget 6

Hyperbaric oxygen therapy (HBOT) is typically very well tolerated. Like all medical therapies, there are always issues that the clinician must consider. Patient safety comes first. One should be aware of contraindications to treating patients in hyperbaric chambers. Although the list is small, it bears mentioning.

The one primary contraindication for “diving” a patient in a monoplace or multiplace hyperbaric chamber is an untreated pneumothorax. Should this condition exist, the higher ambient pressure of oxygen will be transmitted through to the pleural space. If a ball valve phenomenon exists, the gas will expand on ascent (Boyle’s Law) and will be unable to escape. This increased pressure would shift the lung and mediastinum to the opposite side causing a tension pneumothorax.  Treating with a chest tube before a dive would help to avoid the situation. If the pneumothorax occurs during the dive, the patient could be treated inside a multiplace chamber or after ascent with a monoplace chamber.

Prior history of receiving doxorubicin or bleomycin has also been associated with pneumonitis following treatment with HBOT. A careful history is important and the clinician may consider obtaining pulmonary function studies and/or pulmonary consultation prior to initiating therapy.

About the Author

Frank L. Ross, MD, FACS
Frank L. Ross, MD, FACS, is Associate Director of the Helen S. and Martin L. Kimmel Hyperbaric and Advanced Wound Healing Center at NYU Langone Medical Center and an Assistant Professor of Surgery at NYU School of Medicine. He is board certified in General Surgery and Undersea and Hyperbaric Medicine. He is an associate member of the American Professional Wound Care Association, American College of Hyperbaric Medicine, and Undersea and Hyperbaric Medical Society. He is also an advanced open water diver with extensive diving experience.

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