HBO and pulmonary hypertension

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Have there been reports of hyperbaric oxygen therapy contributing to worsening pulmonary hypertension. I had a patient earlier this year that we were treating for Wagner grade 3 diabetic foot ulcer. We stopped at treatment 25 due to progressive shortness of breath.. Echo showed worsening Pulmonary Hypertension for an echo done two years previous. Is it possible that the HBO exacerbated the Pulmonary Hypertension. I have another patient interested in HBO for radiation cystitis with COPD and elevated pulmonary arterial pressures. I am a bit hesitant. Thanks

Nov 9, 2021 by Jad Roeske, MD

5 replies

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

Hello, Jad! Thank you for this interesting question.

My short answer is: "I've searched PubMed and can find nothing relating to pulmonary hypertension and hyperbaric oxygen therapy."

That said, I have some friends who are pulmonologists and subspecialty certified in hyperbaric medicine. I'll run this by them.

Any idea of the etiology of the pulmonary hypertension? I'm sure that I will be asked that question. I'm assuming idiopathic, since that is the most common.

Nov 9, 2021

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

Jad: I just heard from two pulmonologists. They both feel that pulmonary hypertension is not worsened during HBOT ... except ... if there is worsening left ventricular function. Otherwise, they see no physiologic reason for pulmonary hypertension to change.

Nov 9, 2021

Jad Roeske
MD

Thanks so much for the rapid response. I appreciate you going above and beyond. The patient also had multiple comorbid conditions including biventricular heart failure, sleep apnea, B cell lymphoma, previous pulmonary emboli and early vascular dementia. He was unable to tolerate treatment of his sleep apnea because of his dementia. Kept taking off the mask. He ultimately expired at the end of September. I was just concerned because of the worsening pulmonary hypertension and dyspnea after initiation of HBO.

Nov 10, 2021

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

Ah ... a conscientious physician wanting to make sure he didn't hasten the patient's demise.

I applaud your concern and desire to improve care in your department. In this case, I think HBOT did not worsen his condition. You can rest assured. Unfortunately, this patient had so many co-morbidities. The clinical picture is certainly difficult.

gene

Nov 10, 2021

Jad Roeske
MD

Thanks so much! I appreciate your assistance and reassurance.
Jad

Nov 10, 2021

* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

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