Thoracentesis and HBO

I have a 90 y/o male patient who underwent thoracentesis about 3 months ago, looking for HBOT for radiation cystitis and intractable repeated urinary bleeding. Post tap cxr showed no pneumothorax, and a repeat cxr performed 5/30 showed small pleural effusions, no pneumothorax. He has a-fib, pacemaker, on eliquis. His lungs are clear on exam, denies SOB.

Any issues with starting treatment about 3 months after a thoracentesis? Any further workup warranted or advised?
Thanks
Bill

Jun 23, 2023 by Bill Khoury,

1 replies

Eugene Worth
MD, M.Ed., FABA, ABPM/UHM

Hi, Bill! You come up with some thought provoking questions.

I have two major concerns ... 1) Overall physical condition, and 2) why the thoracentesis in the first place?

Reading between the lines, I'm much less concerned over pneumothorax after having the thoracentesis and HBOT. You can mitigate that if you slow the pressurization/depressurization phase. Make it 10 minutes rather than 5 - 7 minutes for a 2.4ATA excursion, for example.

So, that said, if this gentleman were 50 years old and had a chest tube for traumatic chest injury and wanted to SCUBA dive, I'd say "Pick another hobby." But, this man is at a somewhat higher risk, only had a needle thoracentesis, and a need for HBOT. I would make the decision rest upon overall physical condition.

Just my opinion.

Jun 24, 2023

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