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CONTRAINDICATIONS OF HYPERBARIC OXYGEN THERAPY

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Medical information reviewed by: ALEX MUNTEANU, Kinetoterapeut

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Discover the hyperbaric medicine center opened within our clinic.

Centrokinetic has the most advanced hyperbaric chamber in Bucharest, with multiple medical and anti-aging applications. The Baroks chamber has 5 seats and operates at a constant pressure of 3 atmospheres, being fully automated and featuring protocols dedicated to each condition, allowing individualized use for each patient.

Hyperbaric therapy – benefits

Patients who choose the clinic’s hyperbaric therapy services benefit from:

  • The only medically accredited hyperbaric therapy chamber in Bucharest, operating at 3 atmospheres (aesthetic-use chambers work at 1 atmosphere and have no medical benefits).
  • A safe medical procedure, with no radiation, no pain, and no side effects. The chamber provides full protection against CoVid-19 transmission, as each patient has an individual mask during therapy, and all breathing movements are done exclusively through this pressurized mask.
  • A specialized medical team consisting of rehabilitation doctors, orthopedists, rheumatologists, neurologists, and neurosurgeons. A multidisciplinary team specialized in all conditions that can be treated with hyperbaric therapy.
  • Premium conditions at an affordable and fair price. Our clinic is known for the quality of its facilities and care for each patient. However, there is no need to pay exorbitant prices to access quality medical services. At Centrokinetic, you’ll find a fair and affordable price. Please note that we do not have a contract with the National Health Insurance House (we do not offer state-reimbursed services).

Centrokinetic is in constant contact with prestigious clinics and universities from Belgium, the Netherlands, France, and Greece to continuously update treatments and offer patients the best medical solutions.

What are the effects of oxygen therapy on the body?

  • Reduces inflammation
  • Increases body oxygen saturation by 20–30%
  • Boosts immune function
  • Improves blood circulation and stimulates the formation of new capillaries
  • Reduces toxins in the body
  • Stimulates the formation of new blood cells
  • Accelerates healing rate

Absolute contraindications

Untreated pneumothorax represents an absolute contraindication to hyperbaric oxygen therapy. When a patient is placed in a chamber where air pressure changes, severe pneumothorax may occur, which can quickly become life-threatening. Each patient with pneumothorax should be treated (thoracostomy) before undergoing hyperbaric oxygen therapy.

The use of certain medications before or during hyperbaric oxygen therapy is also an absolute contraindication. Doxorubicin and Cisplatin are both chemotherapy drugs, while Disulfiram is used in the treatment of alcoholism, and Mafenide acetate (Sulfamylon) is used for treating bacterial infections in burns. During hyperbaric oxygen therapy, these drugs have been observed to become toxic.

Doxorubicin used during therapy can increase the risk of cardiotoxicity and should be stopped 24 hours before therapy.

Bleomycin can cause interstitial pneumonia and fibrosis, but patients can safely undergo therapy if the medication has been discontinued for at least 6 months.

Disulfiram, by blocking superoxide dismutase, can increase the risk of oxygen toxicity (seizures and pulmonary toxicity) and should not be taken concurrently with hyperbaric oxygen therapy.

Relative contraindications

Cisplatin, together with HBOT, is a relative contraindication because the drug treatment may become ineffective. It is not an absolute contraindication since no adverse effects occur.

Chronic obstructive pulmonary disease (COPD) may increase the risk of hypercarbia. The large volume of inhaled oxygen raises blood oxygen saturation, leading to induced hypoventilation.

Asthma may lead to air trapping between the pleural layers and pulmonary barotrauma. Similarly, air bubbles and asymptomatic lesions observed in chest X-rays are also relative contraindications as they may lead to pneumothorax.

Implants should be tested to prove their safety and ability to withstand a high-pressure environment. Although most devices are built to resist up to 4 atmospheres, it is always advisable to verify this with the manufacturer.

In patients with epidural anesthetic pumps, there is a risk of pump damage due to pressure. It is recommended to contact the device manufacturer to verify resistance to this pressure level.

Pregnancy has generally been considered a relative contraindication due to unknown effects on the fetus. However, recent studies have shown that pregnancy can, in certain circumstances, be an indication. Pregnant women can benefit from hyperbaric oxygen therapy in cases of carbon monoxide poisoning. Due to the high affinity of fetal hemoglobin for oxygen and carbon monoxide, HBOT has shown good results in CO intoxication.

High fever (>39°) or epilepsy may lower the seizure threshold, increasing the likelihood of oxygen toxicity. The risk of oxygen-induced toxicity leading to seizures in patients with a high risk (e.g., post-brain surgery) remains unknown. Antiepileptic and antipyretic drugs may help reduce this risk.

Inability to equalize ear or sinus pressure, possibly due to prior surgery, radiation exposure, or acute upper respiratory infections, may cause pain or barotrauma. For example, otosclerosis can be problematic. Patients with acute congestion or mild difficulty in equalizing ear pressure can be treated with phenylephrine nasal spray. If treatments are ineffective, a tympanostomy tube placed in the eardrum is recommended before HBOT.

Eustachian tube dysfunction may increase the risk of tympanic membrane barotrauma. It is recommended that patients undergo pressure-equalization training or receive tympanostomy tubes before starting therapy.

Claustrophobia may represent a contraindication depending on severity, control with anxiolytics, and the size of the chamber. In severe cases where patients may endanger themselves, claustrophobia is considered an absolute contraindication.

Ophthalmologic surgeries may be problematic if air remnants are trapped in the eye, as air expansion or contraction can affect vision.

Thoracic surgery may increase the risk of atelectasis or pneumothorax. A thorough evaluation should be performed prior to therapy.

Spontaneous pneumothorax is a relative contraindication, and a detailed evaluation is recommended before proceeding.

Asymptomatic lung lesions detected by X-ray should be evaluated to determine their cause before treatment.

History of optic neuritis or sudden vision loss is a relative contraindication, although limited studies exist. Moreover, HBOT has shown therapeutic benefits for patients with radiation-induced optic neuritis, central retinal artery occlusion, retinal vein occlusion, macular edema, etc. Therefore, patients with a history of eye disease should be clinically evaluated to assess potential risks and benefits.

Insulin-dependent diabetes or acute hypoglycemia are relative contraindications due to therapy-induced hypoglycemia. Frequent glucose monitoring is usually sufficient to perform HBOT safely.

Nicotine and caffeine use or dependence are contraindicated before starting therapy. Vasoconstriction induced by these agents reduces therapy efficiency. For the same reason, cocaine and amphetamines are also contraindicated.

Congenital spherocytosis has been considered risky because the increased partial oxygen pressure can cause hemolysis. However, some cases have been reported where patients were treated safely.

Perilymph fistulas, resulting from inner ear barotrauma, cause vertigo and other vestibular symptoms that may be worsened by therapy, as oxygen is forced into the cochlea.

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