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Understanding the Risks of Hyperbaric Oxygen Therapy

Insights from the Hyperbaric Treatment and Wound Care Center​

Hyperbaric Oxygen Therapy (HBOT) stands at the forefront of innovative treatments in the medical world, particularly in the domain of wound care. By immersing the body in an environment with 100% oxygen at pressures surpassing regular atmospheric levels, HBOT has shown remarkable efficacy in expediting the wound healing trajectory. At the University Health Partners of Hawaii Hyperbaric Treatment and Wound Care Center, this therapy is not just limited to wound care. It has been effectively employed to address a myriad of medical conditions, from decompression sickness, commonly known as “the bends” (a risk associated with scuba diving) to serious infections and even wounds that resist healing due to complications like diabetes or radiation injury.

However, as with any medical intervention, HBOT is not devoid of risks. This article, drawing insights from the expertise of the University Health Partners of Hawaii Hyperbaric Treatment and Wound Care Center, aims to shed light on the potential risks accompanying HBOT when employed for wound care purposes.

Understanding Pressure-Related Injuries

When undergoing HBOT, the body is subjected to increased pressure, which can lead to injuries, especially in the ears and nose. These injuries can manifest in various ways:

Ear Pain: As the pressure inside the chamber increases, patients might experience discomfort or pain in their ears. This sensation is similar to what one might feel when ascending or descending in an airplane.

Ruptured Eardrum: In more severe cases, if the pressure isn’t equalized correctly during the therapy, it can lead to a ruptured eardrum. A ruptured eardrum can cause pain, hearing loss, and discharge from the ear.

Nose Injuries: Just as the ears are susceptible to pressure changes, the nasal passages and sinuses can also be affected. This can lead to discomfort, congestion, or nosebleeds.

Measures to minimize the risk of these injuries:

Equalizing Pressure: Patients are taught techniques to equalize the pressure in their ears during the therapy, similar to methods used while scuba diving or flying.

Communication: It’s crucial for patients to communicate any discomfort or pain they feel during the session. The therapist can make adjustments to the pressure or offer guidance on equalization techniques.

Pre-Treatment Assessment: Before undergoing HBOT, patients should have a thorough medical assessment. Those with a history of ear or sinus issues may need additional precautions.

What is Temporary Nearsightedness (Myopia)?

Myopia, commonly referred to as nearsightedness, is a condition where close objects can be seen clearly, but distant objects appear blurred. In the context of HBOT, some patients have reported experiencing temporary myopia as a side effect of the treatment.

How Does HBOT Cause Temporary Myopia?

During HBOT, the body is exposed to increased oxygen levels under high pressure. This environment can cause the lens of the eye to change shape or swell, leading to a temporary shift in vision. As a result, patients may experience nearsightedness.

Symptoms and Duration

Patients undergoing HBOT might notice:

  • Blurred vision when looking at distant objects.
  • A need to squint or strain the eyes to see clearly.
  • Headaches due to eye strain.

This change in vision is typically temporary. Most patients find that their vision returns to normal within days to weeks after completing their HBOT sessions.

Managing and Preventing Temporary Myopia

Communication: Patients should inform their healthcare provider if they notice any changes in their vision during or after HBOT.

Regular Eye Check-ups: Regular eye examinations can help monitor any changes in vision and ensure that they are temporary and related to HBOT.

Rest: Giving the eyes adequate rest and avoiding straining them can help in faster recovery.

Oxygen Toxicity and Seizures

Oxygen toxicity occurs when the body is exposed to excessive levels of oxygen. In the context of HBOT, this can happen if the body receives more oxygen than it can handle. One of the most severe manifestations of oxygen toxicity is the onset of seizures.

How Does Oxygen Toxicity Lead to Seizures?

During HBOT, the body is exposed to high concentrations of oxygen. While oxygen is vital for our survival and has therapeutic benefits, too much of it can be harmful. Excessive oxygen can lead to the overproduction of free radicals in the body. These free radicals can damage nerve cells in the brain, leading to seizures.

Symptoms and Management

Patients undergoing HBOT should be aware of the signs of oxygen toxicity, which include:

  • Visual or auditory disturbances
  • Nausea or dizziness
  • Twitching or muscle spasms
  • Disorientation or confusion

If any of these symptoms are observed, it’s crucial to alert the medical staff immediately. Immediate intervention can prevent the progression to full-blown seizures.

Preventing Seizures During HBOT

Medical History: Before undergoing HBOT, patients should share their complete medical history with their healthcare provider. Individuals with a history of seizures or neurological conditions might need additional precautions.

UHPs HBOT specialists will ensure that the correct amount of oxygen is administered during the therapy and will continuously monitor patients during the therapy session to detect any early signs of oxygen toxicity.

What is Decompression Sickness?

Decompression sickness occurs when the body experiences a rapid decrease in pressure. This can lead to the formation of nitrogen bubbles in the bloodstream. Under normal atmospheric conditions, nitrogen is safely dissolved in the blood. However, during HBOT, the body is exposed to increased pressures. If the pressure in the chamber drops too quickly, it can result in the release of these nitrogen bubbles.

Symptoms of Decompression Sickness

The symptoms of decompression sickness can vary in severity and may include:

  • Joint pain or aches, often described as a deep, throbbing pain.
  • Rashes or itching on the skin.
  • Fatigue or weakness.
  • Dizziness or vertigo.
  • Difficulty breathing or chest pain.
  • In severe cases, paralysis or even death.
  • Managing and Preventing Decompression Sickness

Gradual Decompression: UHP specialists will ensure that the decompression process is gradual and controlled to prevent the rapid formation of nitrogen bubbles.

Monitoring: patients are continuously monitored during HBOT for early signs of decompression sickness.

Immediate Medical Attention: if a patient shows any signs of decompression sickness, they will receive immediate medical attention. Treatment may involve recompression or the administration of pure oxygen.

Patient Education: before undergoing HBOT, patients will be educated about the risks and symptoms of decompression sickness.

Pneumothorax occurs when air leaks into the space between the lung and the chest wall. This air pushes on the outside of the lung, causing it to collapse partially or entirely. In the context of HBOT, a rapid change in pressure can lead to this condition.

How Does HBOT Lead to Pneumothorax?

During an HBOT session, the body is exposed to increased pressures. If the pressure in the chamber decreases too swiftly, it can lead to the formation of air bubbles that can migrate and cause the lung to collapse. This rapid depressurization is a significant risk factor for pneumothorax during HBOT.

Symptoms and Immediate Actions

Patients undergoing HBOT are monitored for the following symptoms, which might indicate a collapsed lung:

  • Sudden sharp chest pain
  • Difficulty breathing or shortness of breath
  • Rapid heart rate
  • Cyanosis (bluish color of the skin or lips)

If any of these symptoms manifest, alert the medical staff immediately. Pneumothorax requires prompt medical attention, and in severe cases, a procedure to remove the air and allow the lung to re-expand.

Prevention and Precautions

Gradual Decompression: to prevent pneumothorax, the decompression process during HBOT is gradual and controlled.

Continuous Monitoring: patients are  continuously monitored during the therapy session to detect any early signs of a collapsed lung.

Medical History: before undergoing HBOT, patients should share their complete medical history with their healthcare provider. Individuals with a history of lung diseases or previous episodes of pneumothorax might need additional precautions.

What is Hypoglycemia?

Hypoglycemia refers to an abnormally low level of sugar (glucose) in the blood. Glucose is the primary source of energy for the body’s cells, and a drop in its levels can lead to a range of symptoms, from mild to severe.

How Does HBOT Lead to Hypoglycemia?

During HBOT, the body is exposed to 100% oxygen at elevated pressures. This environment can influence metabolic processes, including the way the body processes glucose. For diabetic patients, especially those on insulin or other glucose-lowering medications, the therapy can exacerbate the drop in blood sugar levels, leading to hypoglycemia.

Symptoms and Immediate Actions

Patients undergoing HBOT, especially those with diabetes, should be aware of the following symptoms of hypoglycemia:

  • Shaking or trembling
  • Sweating
  • Rapid heartbeat
  • Dizziness or lightheadedness
  • Sudden mood changes
  • Fatigue or weakness
  • Blurred vision
  • Headache
  • Hunger

If any of these symptoms are observed, inform the medical staff immediately. Quick interventions, such as consuming a glucose-rich snack or drink can help restore blood sugar levels.

Prevention and Precautions

Regular Monitoring: diabetic patients should monitor their blood sugar levels before and after HBOT sessions to ensure they remain within a safe range.

Dietary Adjustments: consuming a balanced meal before the therapy can help stabilize blood sugar levels.

Medication Review: your primary healthcare provider should review and, if necessary, adjust your diabetes medications prior to your treatment.

Patient Education: UHP patients are educated about the risks of hypoglycemia and the importance of regular blood sugar monitoring.

The heart is a vital organ responsible for pumping blood throughout the body. Any disruption or stress to its function can have significant consequences. HBOT, which involves exposing the body to 100% oxygen at elevated pressures, can sometimes pose challenges to heart function.

How Does HBOT Lead to Heart Complications?

HBOT increases the amount of oxygen in the blood, which can influence various metabolic processes, including those related to heart function. For individuals with pre-existing heart conditions or those at risk, the increased oxygen levels and pressure changes can exacerbate heart-related issues.

Symptoms and Immediate Actions

Patients undergoing HBOT should be aware of the following symptoms that might indicate heart complications:

  • Chest pain or discomfort
  • Shortness of breath
  • Palpitations or irregular heartbeat
  • Dizziness or lightheadedness
  • Fatigue or weakness
  • Swelling in the legs, ankles, or feet

If any of these symptoms manifest, alert the medical staff immediately. Early detection and intervention can prevent severe complications.

Prevention and Precautions

Medical History Review: before undergoing HBOT, patients should share their complete medical history, especially any heart-related issues, with their healthcare provider. This will help in assessing the risks and determining the appropriateness of the therapy.

Continuous Monitoring: heart rate, blood pressure and oxygen levels are continuously monitored during the therapy session to detect any early signs of heart complications.

Limiting Session Duration: the duration of each HBOT session will be tailored to the individual’s needs and health status. Prolonged exposure might increase the risk of heart complications for some patients.

HBOT, as practiced at the University Health Partners of Hawaii Hyperbaric Treatment and Wound Care Center, is a safe and effective treatment for a range of medical conditions, from decompression sickness to serious infections and wounds resulting from diabetes or radiation injury. As with any medical procedure, there are potential risks associated with the treatment. By ensuring proper patient screening, continuous monitoring during sessions and strict adherence to established protocols, these risks can be effectively mitigated. As always, in any medical scenario, the benefits of treatment will be carefully balanced against potential risks to prioritize the patient’s safety and overall well-being.

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