Precautions and contraindications

Hyperbaric oxygen therapy (HBOT) is considered a safe, comfortable and non-invasive procedure, but we need to be cautious about the risks, adverse effects and contraindications.

At AHA Hyperbarics, we emphasize the importance of training and safety. Precautions and contraindications are put in place to ensure that users are medically cleared for treatment and can benefit safely from the therapy.

General recommendations before treatment

• It is advised for smokers not to smoke at least two hours before the treatment and two hours after the treatment, otherwise the effect is not as beneficial. Smoking may even negate it.
• It is advised not to drink coffee at least one hour before the treatment.
• It is advised to wear cotton underwear.
• Provided you use makeup, it is advised to come without it. If that is not possible, you will be asked to remove your makeup with a special wet wipe before the treatment.
• No us of mobile phones and electronic devices.
• No oil, glue and alcohol based products.

Pressure equalization

All staff members in a hyperbaric facility must be instructed and educated to swiftly recognize symptoms of developing pressure injuries. Rates of raising and lowering pressure should be slow and cautiously regulated. When a significant sign is discerned during the phase of raising the pressure, the operator should suspend the compression and slightly depressurize the chamber until the occupant confirms that their problems (usually pain) are gone. The problem may be alleviated by attempting equalization in as many ways as possible and with decongestants. In certain more serious cases the hyperbaric treatment needs to be terminated for a medical intervention (a surgical incision in the eardrum, which relieves pressure or pus from the middle ear) or to allow spontaneous recovery of the function of the Eustachian tube.

Everyone involved in hyperbaric treatments must be acquainted with how to prevent middle and inner ear barotrauma. Where possible, refrain from treatments, when considerable congestion, discharge or infections of upper respiratory tract are present. In case this is possible, let the occupant sit rather than lie. Rational use of nasal or systemic drugs that decrease decongestion is allowed. The operator should also make sure that the rates of descent and ascent are properly slow. They should also teach the occupant to apply various equalizing methods and observe that they’re applying them correctly. If they notice that the occupant is not equalizing properly, the operator must guide them on how to do that or how to use various equalization methods at once.

The methods of equalization are: Modified yawning and swallowing, the Frenzel manoeuvre (closing the nostrils and closing the back of the throat, then making the sound of the letter “K”, pushing the tongue upward and compressing the air into the Eustachian tubes), the Toynbee manoeuvre (similar to the Frenzel manoeuvre – pinching the nose shut and swallowing, which opens the Eustachian tubes) and gentle Valsalva technique (pinching close the nose and gently blowing).

Claustrophobia   

Hyperbaric oxygen treatment (HBOT) is generally a pleasant experience. We are all claustrophobic to some extent, so expect to feel slight apprehension because this is normal. All operators are trained to assist the user in such a way that the treatment proceeds as relaxing, pleasant and calmly as possible.

Claustrophobia or an irrational fear of enclosed or narrow spaces usually occurs within the first few minutes of the treatment. It is more pronounced in people who experience this sort of fear in their everyday lives, but may also affect other people, who have never seen a similar device, have never been administered anything through a facial mask or have never been in a pressurized space. Such people experience fear almost immediately upon placing the mask on their face inside the chamber or upon noticing that the chamber is collapsed in the middle.

Contraindications

It is recommended that the treatment is not performed on a user who is diagnosed with any of the mentioned contraindications.

Absolute contraindications

Some medical conditions pose a significant risk when undergoing hyperbaric treatment. These absolute contraindications must be strictly adhered to, as they can result in severe complications during hyperbaric therapy.

• unvented pneumothorax/ history of pneumothorax
• acute severe bronchospasm
• unvented cavities
• using of drugs: Bleomycin, Cisplatin, Disulfiram (Antabuse), Doxorubicin hydrochloride (Adriamycin), Mafenide acetate (Sulfamylon)

Bleomycin
Commonly used as an anticancer agent for chemotherapy in the treatment of Hodgkin’s lymphoma, squamous cell carcinomas, testicular cancer and plantar warts. It causes interstitial pneumonitis. The medicine must be eliminated from the body before HBOT (48 hours required from the termination of medication).

Cisplatin
Commonly used to treat various types of cancers, including sarcomas, some carcinomas (e.g. small cell lung cancer, and ovarian cancer), lymphomas, and germ cell tumours. Causes impaired wound healing. The medicine must be eliminated from the body before HBOT (48 hours required from the termination of medication).

Disulfiram (Antabus)
Commonly used to support the treatment of chronic alcoholism by producing an acute sensitivity to alcohol.Blocks superoxide dismutase, lessening protection from oxygen toxicity seizures. The medicine must be eliminated from the body before HBOT (48 hours required from the termination of medication).

Doxorubicin hydrochloride (Adriamycin)
Commonly used in the treatment of a wide range of cancers, including hematological malignancies, many types of carcinoma, and soft tissue sarcomas. Blocks superoxide dismutase, lessening protection from oxygen toxicity seizures. The medicine must be eliminated from the body before HBOT (48 hours required from the termination of medication).

Mefanide Acetate (Sulfamylon)
Commonly used to treat severe burns. Causes vasodilation (widening of blood vessels). The medicine must be eliminated from the body before HBOT (48 hours required from the termination of medication).

Relative contraindications

While not as dangerous as absolute contraindications, relative contraindications still require careful consideration. These conditions may not restrict hyperbaric therapy but demand closer observation or prior consultation with a medical professional to assess the potential risks and determine whether HBOT is appropriate for the patient.

• upper airway infection (laryngitis, sinusitis, bronchitis)
• Emphysema with CO2 retention
• asymptomatic air cysts or blebs in the lungs seen on chest X-ray
• allergic rhinitis
• chronic otitis
• chronic obstructive pulmonary disease (COPD)
• history of thoracic surgery
• history of ENT surgery
• epilepsy
• optic neuritis
• uncontrolled hypertension
• uncontrolled high fever
• heart failure
• pacemakers
• epidural pain pump
• pregnancy
• claustrophobia
• tumor growth
• congenital spherocytosis
• uncontrolled and/or unstable asthma

Fire protection

There are multiple items and materials, which must not be taken into the chamber due to hazards associated with fire and ignition. Oxygen accelerates combustion, even though it does not burn. High concentration of oxygen inside the hyperbaric chamber requires a number of safety precautions to prevent fires.

Inside the hyperbaric chamber and near the hyperbaric and oxygen equipment are prohibited all materials that ignite quickly, flammable liquids, gases and vapours, and devices that generate sparks. If possible, flammable materials should be avoided for the equipment of a hyperbaric chamber or at least kept to the lowest in case that is not possible.

• Mobile phones
• Hearing aids
• Batteries
• Electronics or anything with an exposed switch
• Watches or jewellery
• Keys
• Coins or money
• Perfume or fresh nail polish
• Medications
• Metal objects not part of the chamber
• Cosmetics, make-up or hair gel
• Non-approved skin lotions
• Newspapers
• Shoes
• Synthetic clothing material
• Any static-producing clothing (use only 100 % cotton clothing)
• Anything containing oil, grease or alcohol
• Any other items deemed unsafe by the HCO

In case of an emergency, the operator must call:

• Emergency phone number 112 (available everywhere in the EU)
• Local emergency phone number (outside the EU)
• AHA Hyperbarics contact number +386 (0)70 20 00 66

Please inform the manufacturer

NOTE: The user must inform the manufacturer and the competent governmental authority of the country, where the user’s place of residence is located, about any and all serious complications relating to the device. The information has to be sent to: AHA Hyperbarics GmbH, Mellergasse 4, A-1230 Vienna and/or support@aha-hyperbarics.com.

Conclusion

Before undergoing any hyperbaric oxygen treatment at AHA Hyperbarics, it is critical to fully understand the contraindications associated with the therapy. Both absolute and relative contraindications must be carefully evaluated to ensure patient safety and to avoid any potential risks. Always consult with a qualified physician to assess your health and receive a medical certificate if necessary.

A clear understanding of these contraindications, as well as the safety protocols in place, ensures that each user has the best possible experience with hyperbaric therapy, leading to effective healing and recovery.

For more in-depth information and professional guidance, refer to the AHA Hyperbarics’ Hyperbaric Chamber Operator Textbook and training materials: https://aha-hyperbarics.com/aha-knowledge/

To determine the contraindications and adverse effects for AHA chambers we take into consideration the following well-recognized literature:

• International ECHM consensus conference, 2016. The authors of the chapter Contraindications to Hyperbaric Oxygen Therapy performed a literature search (1946-2015)
• Textbook of Hyperbaric Medicine, author K. K. Jaine, 5th edition, 2009 (chapter Indications, Contraindications and Complications of HBO Therapy)
• What are contraindications for the use of hyperbaric oxygen therapy, an article published in the well-recognized The Medscape Journal of Medicine (updated: Oct 22, 2018)
• Medical risks of hyperbaric oxygen therapy, an article published on the University of Iowa Hospitals and Clinics website (September 2017)