From the Guidelines
Hyperbaric Oxygen Therapy (HBOT) carries several potential risks and complications, including barotrauma to the ears or sinuses, oxygen toxicity, claustrophobia, and temporary nearsightedness, as reported in a 2019 study 1. The most common side effect is difficulty equalizing pressure in the middle ear, which occurred in 17% of patients, according to a study of 782 patients with 11,376 sessions receiving HBOT for a variety of indications 1. Other potential complications include:
- Oxygen toxicity, which can manifest as seizures, lung inflammation, or temporary vision changes due to exposure to high oxygen concentrations
- Claustrophobia, as treatment takes place in a confined chamber
- Temporary nearsightedness (myopia) that typically resolves within weeks after treatment ends
- Fire risk, as oxygen-rich environments increase combustibility
- Rare but serious complications, such as air embolism (air bubbles in blood vessels), pneumothorax (collapsed lung), and decompression sickness if pressure is reduced too quickly Certain medications, like some chemotherapy drugs, disulfiram, and doxorubicin, may interact negatively with HBOT, and patients with certain conditions, such as untreated pneumothorax, some types of lung disease, recent ear surgery, high fevers, or certain seizure disorders, may not be suitable candidates for this therapy 1. These risks are generally managed through proper screening, monitoring during treatment, and following established safety protocols, as recommended by the 2018 guidelines for the early management of patients with acute ischemic stroke 1. Key considerations for HBOT include:
- Patient selection and screening to minimize risks
- Monitoring during treatment to promptly address any complications
- Following established safety protocols to prevent adverse events
- Weighing the potential benefits of HBOT against the potential risks and complications for each individual patient.
From the Research
Potential Complications of Hyperbaric Oxygen Therapy (HBOT)
The potential complications and risks associated with Hyperbaric Oxygen Therapy (HBOT) include:
- Middle ear barotrauma, which can be prevented or minimized by teaching autoinflation techniques or by inserting tympanostomy tubes 2
- Claustrophobia, which can be addressed through reassurance, coaching, and sedation if necessary 2
- Oxygen toxicity, which can cause progressive myopia, pulmonary dyspnea, and oxygen-induced seizures, especially at higher oxygen pressures 2, 3
- Increased risk of adverse effects when the chamber pressure is above 2.0 ATA or when the treatment course exceeds 10 sessions 4
Risk Factors for Oxygen Toxicity Seizures
Certain risk factors can contribute to the development of oxygen toxicity seizures, including:
- Hypercapnia secondary to chronic obstructive pulmonary disease 3
- Narcotic withdrawal 3
- Alcohol dependence 3
- Use of certain medications, such as antidepressants, tramadol, or cephalosporin/ceftriaxone 3
Adverse Effects of HBOT
Adverse effects of HBOT have been reported in various studies, with the most frequent side effect being ear discomfort 4
- The incidence of adverse effects is higher when the chamber pressure is above 2.0 ATA or when the treatment course exceeds 10 sessions 4
- HBOT is relatively safe when the chamber pressure is lower than 2.0 ATA and the treatment course is 10 sessions or less 4
Timing of HBOT Initiation
The timing of HBOT initiation can impact outcomes, with earlier treatment associated with better neurocognitive prognosis in cases of acute carbon monoxide poisoning 5