Top Ten Things You Need to Know About HBOT #4: What Is HBOT’s Only Contraindication?

In the seventh article in a series, this review article will discuss and give updates on top ten things we need to know about hyperbaric oxygen therapy (HBOT).

 
4

Did you know the only absolute contraindication to HBO therapy is untreated pneumothorax?

The contraindications that health care professionals often associate with HBOT are, contrary to popular belief, relative contraindications. There is only one absolute contraindication to HBOT and that is untreated pneumothorax.¹ Some of the relative contraindications are mentioned below as well as a brief rationale related to their status:
 
    •    Chronic obstructive pulmonary disease (COPD) can increase the risk of hypercarbia secondary to decrease respiratory drive.
    •    Asthma can result in air trapping and the subsequent development of pulmonary barotrauma.
    •    Patients with implanted devices or epidural pain pumps should be aware of the risk of device malfunction and deformation. Although there are no case reports of implanted cardiac defibrillators triggering a fire in a patient in the hyperbaric chamber, we must still take into consideration the risk of dysrhythmia.
    •    Fever can make oxygen toxicity more likely, increasing the risk for seizures during treatment. The risk for this can be alleviated using antipyretics.
    •    History of thoracic surgery can increase the risk of atelectasis and pneumothorax.
    •    The concurrent administration of drugs can cause side effects includes some chemotherapy agents such as doxorubicin (cardiotoxicity), bleomycin (lung fibrosis), mafenide (wound healing may be impared), cisplatin (wound healing may be impaired), and disulfiram (increase risk of oxygen toxicity).^2,3
 
Pregnancy has long been thought to be an absolute contraindication to HBOT, but in reality, in the case of carbon monoxide poisoning, it can be extremely beneficial and improve fetal outcomes. Fetal hemoglobin has a high affinity to oxygen and CO due to its unique composition which includes two alpha and two gamma subunits, rather than two alpha and two beta subunits like in adult hemoglobin. HBOT should be considered in all cases of pregnant CO poisoning cases.4
 
Additional relative contraindications include but are not limited to: claustrophobia, optic neuritis, recent eye surgery, history of seizure disorder, congenital spherocytosis, viral infections, and chronic sinusitis.^3,5
 
Denise Nemeth is a second-year medical student at the University of the Incarnate Word School of Osteopathic Medicine in San Antonio, TX. Formerly a general and vascular surgery PA in a rural community, Ms. Nemeth aspires to become a general surgeon. She is certified wound specialist with the American Board of Wound Management. Her interests include rural health, wound healing, colorectal surgery, and minimally invasive surgery.
 
Jayesh B. Shah is Immediate Past president of the American College of Hyperbaric Medicine and serves as medical director for two wound centers based in San Antonio, TX. In addition, he is president of South Texas Wound Associates, San Antonio. He is also the past president of both the American Association of Physicians of Indian Origin and the Bexar County Medical Society and Current of Board of Trustees of Texas Medical Association.    

Click here to download a PDF of this article.

References
 
1. Jones MW, Cooper JS. Hyperbaric Therapy For Wound Healing. [Updated 2022 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
2. Gawdi R, Cooper JS. Hyperbaric Contraindications. [Updated 2021 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
3. Rios P, Ponse Y, Shah JB, Hyperbaric oxygen therapy, Chapter 27. In Shah JB, Milne CT. Wound Care Certification Study Guide, 3rd Edition, 2021, Best Publishing Company.
4. Arslan A. Hyperbaric oxygen therapy in carbon monoxide poisoning in pregnancy: Maternal and fetal outcome. Am J Emerg Med. 2021;43:41–45. doi: https://doi.org/10.1016/j.ajem.2021.01.007.
53. DuBose KJ, Cooper JS. Hyperbaric Patient Selection - statpearls - NCBI bookshelf. Kyle J. DuBose; Jeffrey S. Cooper. Published February 2022. Accessed April 12, 2022.