Hyperbaric oxygen therapy (HBOT) involves breathing pure oxygen in a pressurized chamber to increase the amount of oxygen delivered to body tissues. While HBOT offers benefits for various medical conditions, careful consideration must be given to patient selection to ensure safe treatment. Understanding who should not receive hyperbaric oxygen treatment is essential to prevent potential risks.
In this article, we provide an overview of the main contraindications for hyperbaric oxygen therapy and highlight important considerations for safe clinical practice.
Absolute Contraindications
Absolute contraindications are situations where a specific treatment or procedure should never be used because it could cause severe harm or life-threatening complications. In these cases, the intervention must be completely avoided, regardless of potential benefits.
Untreated Pneumothorax
The only universally recognized absolute contraindication of hyperbaric oxygen therapy is an untreated pneumothorax. When air is trapped in the pleural space, increased air pressure in the chamber can exacerbate the condition, leading to life-threatening barotrauma or tension pneumothorax. The effect of hyperbaric oxygen on a pneumothorax is particularly dangerous because trapped air can expand or rupture under hyperbaric conditions, risking respiratory and cardiac compromise.
Other Absolute Contraindications
Use of HBOT with specific chemotherapy drugs (like doxorubicin or bleomycin)—may be treated as absolute contraindications by hyperbaric medical staff due to heightened risk of oxygen toxicity.
At Quantum Wellness Center, our staff always takes into consideration the client’s health story and makes safety a top priority before the start of any HBOT session.
Relative Contraindications
Chronic Obstructive Pulmonary Disease (COPD) with Air Trapping
Patients with chronic obstructive pulmonary disease (COPD), especially if there is underlying air trapping or bullous disease, are at risk of pulmonary barotrauma. HBOT increases the risk of air embolism or rupture of pulmonary bullae, which can lead to severe complications.
Upper Respiratory Infections and Sinusitis
Active respiratory tract infections, such as upper respiratory infections or sinusitis, raise the risk of barotrauma to the ears and sinuses due to impaired pressure equalization during pressurization and depressurization in the hyperbaric chamber.
Febrile Illness
Fever increases metabolic demands and may worsen the toxic effects of oxygen under hyperbaric oxygen therapy, so the administration of hyperbaric oxygen should be carefully considered when patients are acutely febrile.
History of Thoracic Surgery
Patients with a history of thoracic or pulmonary surgery may have residual trapped air or pleural adhesions. These conditions amplify the potential risks of pressure changes during HBOT.
Seizure Disorders
Seizure disorders, including epilepsy, are a relative contraindication because hyperbaric treatment, especially at high oxygen concentrations and prolonged exposure, can increase the risk of oxygen-induced seizures, one of the main toxic effects of oxygen.
High Fevers and Hyperthermia
Elevated body temperature heightens the risk of oxygen toxicity and worsens the potential complications associated with oxygen exposure under pressure.
Additional Medical Conditions to Consider
Cardiovascular Disease
Heart failure, unstable angina, or severe arrhythmias may worsen under hyperbaric conditions due to changes in oxygen dose and pressure. Medical staff must weigh the risks and benefits of hyperbaric oxygen therapy in these cases.
Uncontrolled High Fever
As noted, fever increases oxygen consumption and toxicity risk, highlighting the need for temperature control before starting hyperbaric oxygen therapy.
Pregnancy
The use of hyperbaric oxygen therapy in pregnancy remains controversial. While not an absolute contraindication, current evidence from the Undersea and Hyperbaric Medical Society and other sources suggests it should be reserved for urgent, life-threatening indications (such as carbon monoxide poisoning) and only when benefits clearly outweigh risks.
Medication Interactions and Precautions
Certain chemotherapy drugs, particularly doxorubicin, bleomycin, and cisplatin, are associated with increased toxicity when combined with hyperbaric oxygenation. Other medications, such as disulfiram, some antibiotics (notably sulfonamides), and drugs that lower the seizure threshold, must be reviewed before a trial of hyperbaric oxygen. Medical staff should also assess recent radiation therapy, as tissue changes can enhance oxygen toxicity or complicate wound healing.
Device and Implant Considerations
Patients with implanted pacemakers, infusion pumps, or electronic devices face potential malfunction or displacement due to increased pressure in the chamber and oxygen exposure. Both multiplace and monoplace chambers have unique considerations, but multidisciplinary review is required before hyperbaric therapy can be safely performed.
Pediatric and Geriatric Special Considerations
Children and the elderly present unique challenges when treated with hyperbaric oxygen. They may be less able to communicate symptoms, more prone to changes in pressure and oxygen levels, and metabolize oxygen differently. Certified hyperbaric professionals must closely monitor these populations for any possible complications.
Risk Mitigation and Screening Protocols
- Pre-treatment screening should identify any contraindication, absolute or relative, prior to starting hyperbaric oxygen therapy.
- Assessment includes detailed history (including respiratory, cardiac, and neurological conditions), medication review, device screening, and physical examination.
- Continuous monitoring during and after hyperbaric oxygen therapy sessions helps prevent complications.
- Education ensures patients know the signs of oxygen toxicity (such as vision changes, nausea, seizure, or confusion), and when to alert medical staff inside or outside of the chamber.
Final Thoughts from Quantum Wellness Center
Understanding absolute contraindications, such as untreated pneumothorax, and weighing relative contraindications allows for optimized patient safety and maximizes the benefits of hyperbaric therapy, from wound care to emergency indications.
At Quantum Wellness Center, your safety is our top priority. Our team carefully evaluates each client for potential contraindications before starting hyperbaric oxygen therapy, ensuring every session is both safe and effective. In our luxurious, stress-free environment, you can relax knowing your treatment plan is customized to meet your unique needs, allowing you to experience the full benefits of advanced HBOT with confidence and peace of mind.
