Can Hyperbaric Oxygen Therapy Cause Chest Pain?
Yes, hyperbaric oxygen therapy can cause chest pain, primarily through pressure-related barotrauma affecting the thoracic cavity, though this is uncommon in appropriately screened patients.
Mechanisms of Chest Pain During Hyperbaric Treatment
Pressure-Related Thoracic Effects
- Pressure changes at 2-3 atmospheres absolute (the typical treatment range) can affect thoracic compliance and cause chest tightness or discomfort 1
- During decompression at the end of hyperbaric sessions, gas expansion in any trapped air spaces can cause significant discomfort or pain 2
Pulmonary Barotrauma Risk
- The most serious cause of chest pain during hyperbaric oxygen therapy is pulmonary barotrauma, which can lead to pneumothorax 3, 2
- Pre-existing pulmonary blebs, bullae, or emphysematous airspace abnormalities significantly increase the risk of barotrauma-related chest pain and complications 3
- Tension pneumothorax during decompression represents an absolute emergency, as decreasing chamber pressure causes rapid gas expansion in the pleural space 2
Cardiac-Related Chest Pain
- Patients with underlying coronary artery disease may experience angina during hyperbaric oxygen therapy due to increased myocardial oxygen demand 4
- Carbon monoxide poisoning patients (a common indication for hyperbaric therapy) frequently present with chest pain as part of their initial toxicity syndrome 4
Clinical Risk Stratification
High-Risk Features Requiring Pre-Treatment Imaging
- Known history of chronic obstructive pulmonary disease, asthma, or other structural lung disease 3
- Previous spontaneous pneumothorax 3
- Recent thoracic surgery or trauma 3
- Active respiratory symptoms (dyspnea, persistent cough, hemoptysis) 3
Low-Risk Patients
- Routine chest X-ray or CT scanning before hyperbaric oxygen therapy in asymptomatic patients without pulmonary history has low clinical value 3
- Most patients who undergo hyperbaric oxygen therapy likely have incidental pulmonary abnormalities (blebs/bullae), yet pulmonary barotrauma remains rare 3
Critical Management Considerations
Prevention
- Thorough pre-treatment screening for pulmonary disease and cardiac conditions is essential 3
- Any known pneumothorax must be drained with chest tube placement before initiating hyperbaric oxygen therapy 2
- Patients should be instructed to equalize pressure frequently during compression and decompression phases 3
Emergency Response
- If chest pain develops during treatment with signs of pneumothorax, immediately increase chamber pressure to prevent tension pneumothorax expansion during decompression 2
- An experienced physician capable of performing emergency procedures (including chest tube insertion) should be immediately available during all hyperbaric sessions 2
- Have equipment for emergency thoracostomy readily accessible inside the hyperbaric chamber 2
Common Pitfall to Avoid
Never allow hyperbaric oxygen therapy to delay or interfere with standard care for the underlying condition 1. For example, in carbon monoxide poisoning with chest pain, concurrent cardiac evaluation and management should proceed alongside hyperbaric treatment 4.