Complications
This is the most common adverse effect of hyperbaric oxygen therapy. A pressure gradient develops across the tympanic membrane, followed by haemorrhage or serous effusion.
Pulmonary barotrauma is rare, but a pneumothorax needs to be treated immediately.[39]
Ear barotraumas should be treated with auto-insufflation techniques, topical and oral decongestants, and tympanostomy tube placement. A chest tube is required for pneumothorax.
A history of carbon monoxide exposure should raise suspicion about the possible aetiology. ECG, cardiac markers, and cardiac monitoring should be performed.
The risk of seizures is 1 to 4 in 10,000 in-patient treatments with hyperbaric oxygen. Patients with acidosis, sepsis, or hypercapnia are at a higher risk for seizures.[39]
Seizures should be managed by reducing the inspired oxygen tension.
Excessive or inappropriate oxygen supplemental therapy can result in cellular injury through formation of reactive oxygen species.
Pulmonary complications of oxygen toxicity include reduced vital capacity, pulmonary fibrosis, ARDS, and impaired gas exchange.[39][47]
Pulmonary complications are rare with standard treatment protocols, so close compliance with these protocols is advised to avoid complications.
Fire accidents can occur if a source of fire or ignition is placed in the hyperbaric oxygen chamber.[39]
Fire accidents are preventable. Patients should be advised against using cigarette lighters and inflammable substances in the chamber.
Reported rates vary widely (1% to 47%) due to inconsistencies in the definition of DNS in studies.[15] DNS is thought to result from vascular insults leading to pathological changes. The average lucid interval between recovery from the initial exposure and development of DNS is about 22 days.
The benefits of hyperbaric oxygen therapy in reducing the incidence of DNS are controversial.[48]
One third of patients may have subtle memory deficits after carbon monoxide poisoning.
One third of patients may have personality changes after carbon monoxide poisoning.
Caused by muscle cell injury. Muscular pain or discomfort is common, but it can have no symptoms or physical signs. Diagnosis is confirmed with a CK level increased to at least 5 times normal, and fluid hydration is the mainstay of therapy.
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