Title
Contraindications and Relative Risks of Hyperbaric Oxygen Treatment
Authors
Phi-Nga Jeannie Le, M.D., Carlos Rene Dostal, M.D., Ph.D.
Medical Book
Hyperbaric Medicine Practice
Introduction
Screening patients for conditions posing contraindications or relative risks for treatment with hyperbaric oxygen (HBO2)
is imperative. Thus, obtaining a thorough history during the initial consultation is vital. All medical treatments and
procedures, especially HBO2 therapy, inherently entail a risk-benefit analysis. The more complete and accurate a
patient’s medical history, the more reliable the risk-benefit analysis. It is impossible to account for every situation about
which a physician must determine if the risks of HBO2 therapy would outweigh the benefits; however, if key concepts
are kept in mind, then one may extrapolate and make a clinically sound decision.
Key concepts:
- 100% oxygen is a metabolic gas with both therapeutic effects and toxicity dose-dependent on
elevated O2 tension (partial pressure).18,116
- Increasing and decreasing pressure will always enforce the gas laws on any gas-filled space.113
When confronted with a condition not explicitly addressed here, ask the fundamental question: how could this
condition, drug, or device be complicated by high O2 tension, and how could it be complicated by increasing or
decreasing ambient pressure?
In this chapter, contraindications and relative risks are categorized according to their mechanism of action, e.g.
mechanism by trapped gas, mechanism by pressurization/depressurization and mechanism by O2 toxicity. Following
this, a literature review and management considerations are provided for each contraindication and relative risk. Where
relevant, a notation is made when expert disagreement exists regarding contraindications, relative risks, and their
management.