How should I assess a patient for potential contraindications to hyperbaric oxygen therapy?

To assess a patient for potential contraindications to hyperbaric oxygen therapy (HBOT), begin with a thorough clinical history and examination focusing on conditions that may increase risk during treatment. Key contraindications include untreated pneumothorax, as HBOT can exacerbate this condition, and certain pulmonary diseases such as severe chronic obstructive pulmonary disease (COPD) with air trapping, which may predispose to barotrauma ¹.

Evaluate for any history of middle ear or sinus disease, as these can cause barotrauma during pressure changes in HBOT (Surman, 1996). Assess for claustrophobia or inability to tolerate the hyperbaric chamber environment, which may limit treatment feasibility (Surman, 1996). Consider cardiac status, as unstable cardiac conditions may increase risk during therapy ¹.

Screen for seizure disorders, since HBOT can lower the seizure threshold, and for any concurrent use of medications that may increase oxygen toxicity risk (Oztürk et al., 2013). Pregnancy is generally considered a relative contraindication and should be carefully evaluated ¹.

Additionally, assess for any implanted devices or materials that may be affected by increased pressure or oxygen concentration (Surman, 1996). A baseline pulmonary function test may be useful in patients with known respiratory disease to evaluate risk (NG115) ¹.

In summary, the assessment should integrate clinical history, physical examination, and relevant investigations to identify contraindications such as untreated pneumothorax, severe COPD, middle ear/sinus disease, seizure disorders, unstable cardiac conditions, pregnancy, and claustrophobia, ensuring patient safety during HBOT ¹ (Surman, 1996; Oztürk et al., 2013).