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Complications of Hyperbaric Oxygen Treatment

During hyperbaric oxygen therapy (HBOT), you breathe pure oxygen inside a highly pressured environment. Often, pressure in the chamber is between 1.5 to 3 times greater than normal air pressure.

This therapy first made an appearance in the United States in the early 19th century. It was later used by undersea medicine specialists to treat deep-sea divers who developed decompression sickness, also known as "the bends." It is now used to treat a number of conditions, from severe burns to carbon monoxide poisoning. But, like all medical procedures, it carries some risks.

Side effects and possible complications of HBOT

During HBOT, you lie on a table in an enclosed chamber and breathe oxygen while the pressure inside the chamber is gradually increased. The therapy may last as little as three minutes or as long as two hours before the pressure is returned to normal levels. Because the pressure is so high, some people may have discomfort while in the chamber. You may have ear pain or a popping sensation in the ears.

If done correctly by trained medical staff in a hospital setting, HBOT is considered safe. In order to prevent oxygen toxicity, some people may need to take short breaks during the therapy and breathe "normal" air to prevent tissues in the body from taking in too much oxygen.

The oxygen dose given during the treatment should be determined specifically for each person. Your doctor will consider any health problems you have, as well as your overall health and your age to reduce the risk for side effects and complications.

Possible symptoms or side effects after HBOT can include fatigue and lightheadedness. More serious complications can include:

  • Damage to the lungs

  • Rupturing of the middle ear

  • Damage to the sinuses

  • Changes in vision, causing nearsightedness, or myopia

  • Oxygen toxicity, which can cause lung failure, fluid in the lungs, or seizures

Side effects are generally mild as long as the therapy lasts no longer than two hours and the pressure inside the chamber is less than three times that of the normal pressure in the atmosphere.

HBOT cautions

Hyperbaric oxygen therapy is not safe for everyone. In general, you shouldn't receive HBOT if you:

  • Have a pacemaker

  • Are pregnant

  • Have certain types of lung diseases, because of an increased risk for a collapsed lung

  • Take certain chemotherapy drugs

  • Have a collapsed lung

  • Take the drug disulfiram (Antabuse)

  • Use the topical cream sulfamylon

  • Have heart failure; HBOT can make symptoms worse

  • Have a cold or a fever

  • Are claustrophobic

Precautions to take

The best way to avoid side effects and complications of HBOT is to be treated in a hospital setting with trained medical staff.  There are a very limited number of doctors in the U.S..that are board-certified in the field. At the minimum, your doctor should have at least 40 hours of training and have completed a course from the Undersea & Hyperbaric Medical Society.

Be aware that HBOT outside the hospital setting is largely unregulated. The FDA has approved the use of portable fabric hyperbaric oxygen chambers, and they are used in some chiropractors' offices. But experts say their design and lack of oversight pose the risk for explosion or fire.

Fires or explosions associated with the use of hyperbaric chambers have been linked to approximately 80 deaths worldwide. Today, hyperbaric chambers used in the hospital setting by appropriately trained medical personnel have good safety records. Some businesses offering this therapy do not even have a doctor on staff. If you are seeking HBOT for nonemergency use, seek out an accredited hospital setting only.

Uses of hyperbaric oxygen therapy

Another way to prevent complications is to use HBOT only as intended. HBOT is used to treat many different health conditions including:

  • Severe anemia

  • Carbon monoxide poisoning

  • Injury from crushing

  • Gas gangrene, a form of gangrene in which gas collects in tissues

  • Decompression sickness

  • Select wound healing

  • Brain abscesses

  • Skin grafts and flaps

  • Infection in a bone, called osteomyelitis

  • Delayed radiation injury

  • Flesh-eating disease, called necrotizing bacterial soft tissue infections

  • Air or gas bubble trapped in a blood vessel; this is known as an air or gas embolism

  • Conditions that cause insufficient oxygen levels to reach the body's tissues

  • Skin infections that are causing tissue to die

  • Thermal burns

  • Central retinal artery occlusion

Medicare and many insurance companies generally cover these procedures but may not do so in every circumstance. For example, Medicare does not cover HBOT for the treatment of burns. Check with your insurance plan. 

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