What are the contraindications of Hyperbaric Oxygen Therapy (HBOT)?

Contraindications of Hyperbaric Oxygen Therapy (HBOT)

Severe hemodynamic or respiratory instability is an absolute contraindication for hyperbaric oxygen therapy due to significant risks that outweigh potential benefits in these patients. 1

Absolute Contraindications

• Untreated pneumothorax: Air trapped in the pleural space can expand during decompression, worsening the pneumothorax
• Severe hemodynamic instability: Patients with unstable vital signs should not undergo HBOT 2, 1
• Severe respiratory compromise: Patients requiring high levels of ventilatory support may be destabilized during chamber transport and treatment 2, 1
• Conditions where standard care would be delayed: HBOT should never delay definitive treatment for time-sensitive conditions 1

Relative Contraindications

Cardiovascular Conditions

• Heart failure: Patients with heart failure, especially those with reduced ejection fraction (HFrEF), require careful evaluation due to:
  • HBOT-induced increases in afterload from vasoconstriction
  • Potential decreases in cardiac output during treatment
  • Risk of pulmonary edema development 3

Pulmonary Conditions

• Upper respiratory infections: May impair middle ear and sinus pressure equalization
• History of spontaneous pneumothorax or bullous lung disease: Increased risk of barotrauma
• COPD with CO2 retention: Risk of respiratory depression due to removal of hypoxic respiratory drive

Neurological Conditions

• Seizure disorders: Oxygen at high pressure can lower seizure threshold
  • Patients should be on optimized anti-seizure medications before treatment

Other Medical Conditions

• Recently placed vascular closure devices (<7 days): Potential risk of device failure, pseudoaneurysm formation, and hematoma development 1
• Fever: Increases metabolic demand and oxygen consumption, potentially worsening outcomes
• Malignancy: Controversial - some evidence suggests HBOT may promote tumor growth

Special Considerations

Patient Monitoring Requirements

• Patients with heart failure require:
  • Optimization of fluid status before treatment
  • Maintenance of diuretic therapy during treatment course
  • Close monitoring for signs of pulmonary edema 3
• Patients with vascular closure devices need:
  • Risk-benefit analysis before proceeding with HBOT
  • Consultation between the interventional cardiologist/radiologist and HBOT specialist
  • Monitoring for bleeding or hematoma formation during and after treatment 1

Facility-Related Considerations

• HBOT should only be performed in facilities specifically designed and equipped for critically ill patients when treating those with complex medical conditions 4
• The hyperbaric chamber should ideally be located near the ICU for critically ill patients 4
• Sufficient staff with appropriate training must be available to manage potential complications 4

Risk Mitigation Strategies

1. Pre-treatment evaluation: Thorough assessment of cardiopulmonary status
2. Equipment testing: All devices introduced into the chamber must be tested and certified for hyperbaric use
3. Protocol development: Standard and emergency procedures should be established and documented
4. Staff training: Regular training for managing complications in the hyperbaric environment
5. Continuous monitoring: Vital signs and clinical status should be monitored throughout treatment

By carefully screening patients and addressing contraindications before initiating HBOT, the risk of adverse events can be significantly reduced while maximizing potential therapeutic benefits.