![]() These complications are incredibly rare but can be quite serious, particularly if not recognized.įinally, special consideration needs to be given to any implanted devices a patient may have, as not all are pressure tested. In the middle ear, that presents with the feeling of pressure on the tympanic membranes. Usually, the expanded air exits through the eustation tubes however, if there is significant eustation tube swelling from barotrauma on descent or a misinformed patient who is doing a forceful Valsalva on the ascent, there can be trauma to the TM or the round or oval window of the inner ear.Īir trapping in the lungs or anything that leads to pulmonary over-pressurization including breath holding on depressurization, severe bronchospasm, or a closed glottis from cough fit or seizure can lead to alveolar rupture. The resulting complication depends on where the escaped air dissects to, whether the mediastinum (pneumomediastinum), the visceral pleura (pneumothorax), or the vasculature (arterial gas embolism). On depressurization of the hyperbaric chamber or "ascent," gas expands. Sinus barotrauma tends to result in sinus pain and swelling, however more significant sequelae reported include cranial nerve symptoms. A tooth "squeeze," resulting from an air pocket in the tooth, either from dental decay or a filling, can be quite painful. Usually, air trapping in the sinuses is secondary to a mechanical obstruction, such as polyps or inflammation. Īir flows freely in and out of the sinuses. For patients who are unable to equalize, either from poor technique or for those who are intubated and sedated, there may be the need for myringotomy before treatment. These are graded by TEED classifications, from TEED 0 (symptom only, normal exam) to TEED 5 (rupture of TM). The most common type of barotrauma involves the middle ear and can cause a range of issues from mild hyperemia of the tympanic membrane (TM) to actual rupture of the TM. Barotrauma results from an inability to equalize pressure between the environment and the air-filled space in the body, resulting in a “squeeze.” On pressurization of a hyperbaric chamber or "descent," gas-filled spaces contract, requiring equalization. That is to say, that as pressure increases, volume decreases, and as pressure decreases volume increases. ![]() ![]() This activity describes the complications of HBO and highlights the role of the interprofessional team in the evaluation and management of these patients.īarotrauma can best be understood by understanding Boyle's Law - P1V1 = P2V2. Confinement anxiety is more an effect of the physical space of the chamber and not a true complication. The side effects of oxygen can further be subdivided into three categories: pulmonary, neurologic, and ophthalmologic. ![]() The side effect of pressure is barotrauma, which can affect any closed, air-filled cavity (including but not limited to ears, sinus, teeth, lungs, and bowel). About half of all adverse events fall under the category of "ear pain" and a quarter are classified as "confinement anxiety." When examining the complications of hyperbaric oxygen treatment, there are two categories: side effects of pressure and side effects of oxygen. When adverse, side-effect data was collected from 2009 through 2010 on patients treated in monoplace chambers, it showed side-effect rates estimated around 0.4%. However, there are some adverse side effects. Hyperbaric oxygen therapy (HBOT) is generally a relatively safe therapy for various conditions.
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