What are the complications of hyperbaric oxygen therapy (HBOT)?

Updated: Nov 16, 2020
  • Author: Emi Latham, MD, FACEP, FAAEM, UHM; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

As with any medical therapy, treatment brings both risks and benefits. One of the more frequently seen injuries caused by hyperbaric oxygen therapy (HBOT) is barotrauma (ie, injuries caused by pressure as a result of an inability to equalize pressure from an air-containing space and the surrounding environment). [2, 4, 118]

Table 4. Complications to Hyperbaric Oxygen Therapy (Open Table in a new window)

Complication

Presentation

Treatment

Barotrauma

 

Middle ear (URI, Eustachian tube dysfunction)

Ear pain, fullness

Muffled hearing

Autoinflation technique

Pseudoephedrine/oxymetazoline

Tympanostomy tubes

Wait for URI resolution

Sinus

Sinus pain or bleeding

Oxymetazoline/pseudoephedrine

Antihistamines

Steroid nasal spray

Dental

Tooth pain

Replacement of filling or crown (allows trapped air bubble to escape)

Pulmonary

Dry cough

Chest pain or burning

Decreased vital capacity

No breath-holding

Thoracostomy (if pneumothorax)

Increase decompression time

Round or oval window blowout

Immediate deafness

Tinnitus

Nystagmus, vertigo, or both

Discontinue Valsalva

Refer to ENT

Visual refraction change

 

Lens morphology

Progressive myopia with prolonged number of treatments

Most resolve spontaneously when treatment finished

Cataracts

Clouding of vision

Prescreen for existing cataracts

HBOT generally does not influence cataract formation, except after prolonged (>100) treatments

Oxygen toxicity

 

CNS (Incidence 0.7 per 10,000 treatments at 2.4 ATA)

Seizure

Removal from oxygen source

Resume HBOT with shorter oxygen treatment periods

Does not require medication

Treat hypoglycemia if present

Treat fever if present

Pulmonary

Dry cough

Chest pain or burning

Decreased vital capacity

Decrease total oxygen exposure time (including outside HBOT)


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