Chest Tightness During Hyperbaric Oxygen Therapy
Chest tightness that resolves after HBO therapy is a recognized side effect that typically does not require treatment discontinuation, but warrants careful evaluation to exclude serious cardiopulmonary pathology.
Initial Assessment
When a patient reports chest tightness during HBO therapy, immediately assess for:
- Cardiac ischemia or arrhythmia - Obtain ECG and cardiac biomarkers if symptoms are concerning for acute coronary syndrome 1
- Pneumothorax or barotrauma - Perform chest examination and consider imaging if respiratory distress is present 2
- Oxygen toxicity - Evaluate for other CNS symptoms (twitching, nausea, visual changes) that may accompany pulmonary oxygen toxicity 1
- Anxiety-related symptoms - Distinguish between physiological and psychological causes, as anxiety is common in HBO patients 3
Understanding the Mechanism
The sensation of chest tightness during HBO can result from several physiological changes:
- Increased oxygen partial pressure causes vasoconstriction and altered pulmonary mechanics 1
- Pressure-related changes at 2-3 atmospheres absolute can affect thoracic compliance 4
- Psychological factors including claustrophobia and treatment-related anxiety are prevalent, with studies showing anxiety decreases after initial sessions 3
Management Strategy
If Symptoms Resolve Post-Treatment:
- Continue HBO therapy - Self-limiting chest tightness that completely resolves after decompression is generally benign and does not contraindicate ongoing treatment 1
- Pre-treatment anxiolysis - Consider short-acting benzodiazepines before sessions if anxiety is the primary driver 3
- Patient education and support - Research demonstrates that anxiety significantly decreases after the first 5 sessions as patients transition from "naivety to normalization" 3
- Monitor vital signs during treatment and document symptom patterns 2
If Symptoms Persist or Worsen:
- Immediate decompression and medical evaluation 2
- Cardiology consultation if cardiac etiology suspected 1
- Chest imaging to exclude structural complications 2
- Risk-benefit reassessment - HBO should only continue if benefits clearly outweigh risks for the specific indication 2
Common Pitfalls to Avoid
- Do not dismiss symptoms without proper evaluation - While benign chest tightness is common, serious complications like pneumothorax or cardiac events can occur 1
- Do not delay definitive treatment - HBO should never interfere with standard care for the underlying condition 4
- Do not overlook psychological preparation - One-third of patients seek no additional information between referral and treatment, contributing to anxiety 3
Documentation Requirements
Record the following for each episode:
- Timing of onset relative to compression phase 1
- Associated symptoms (dyspnea, diaphoresis, palpitations) 1
- Duration and resolution pattern 1
- Vital signs during and after treatment 2
When to Discontinue HBO
Absolute indications to stop treatment include:
- Persistent symptoms after decompression 2
- Evidence of pneumothorax or significant barotrauma 2
- Acute coronary syndrome or unstable arrhythmias 2
- Progressive oxygen toxicity symptoms 1
The key distinction is that transient, self-resolving chest tightness is an expected side effect in some patients and does not necessitate treatment cessation, whereas persistent or progressive symptoms require immediate intervention and possible discontinuation 1.