Lisa:

Thank you for the question. The answer is not a simple 'go' or 'no go' and other physicians on this list may well disagree with my opinion. That's fine and gives you more information. The question for me is whether or not this area of damaged lung is "ventilating." You said, "intact but flaccid" ... and I'm confused. So, I would ask my friendly pulmonologist to examine this patient and figure out whether or not the area of lung is 'ventilating' and whether or not there is a component of air trapping. In my mind that would include a ventilation/perfusion test and spirometry. Other tests to consider is a spiral CT of the lung to get a better anatomic picture of what is going on here.

If the answer is 'yes, there is a component of air trapping' then you have a clinical decision point. Although rare, you are exposing this man to 40+ excursions from 1.0 ATA to 2.0 or 2.4 ATA. Boyle's Law applies. If there is air trapping, then whatever amount is trapped at pressure will double or more during decompression. Granted, only one exposure per day, but there is still the same risk with every compression.

So, I haven't given you an answer, but hopefully charted a way to make an informed clinical decision. It may come down to telling/documenting that you informed the patient of the risk (however small), and he decided to continue.

Let's see what others have to say about this ...

Case reports of problems with lung bullae and repeated exposure to pressure ... not meant to scare you ... This is the background of asking whether or not this area of lung is ventilating and presence/absence of air trapping.

Hello Dr Worth,

Thank you for your answer and I understand how that question could become confusing! "intact but falccid" ... (we all were confused as well) but with a lot more research on the pt, the most recent CT scan showed an old atelectasis in which he also was cleared with pulmonology for HBOT. We started him this week with a 1psi/min on ascend/descend / 2.0 ATA. Thank you again for your help