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Pulmonary Edema Associated With Hyperbaric Oxygen Therapy*
We report three cases of pulmonary edema associated with hyperbaric oxygen therapy, including one fatality. All three patients had cardiac disease and reduced left ventricular (LV) ejection fractions (EFs). Two patients had diabetes, and one patient had severe aortic stenosis. Hyperbaric oxygen therapy may contribute to pulmonary edema by increas
ing LV afterload, increasing LV filling pressures, increasing oxidative myocardial stress, decreasing LV compliance by oxygen radical-mediated reduction in nitric oxide, altering cardiac output between the right and left hearts, inducing bradycardia with concomitant LV dysfunction, increasing pulmonary capillary permeability, or by causing pulmonary oxygen toxicity. We advise caution in the use of hyperbaric oxygen therapy in patients with heart failure or in patients with reduced cardiac EFs.
(CHEST 2001; 120:1407-1409)
Key words: adverse effects; heart failure; hyperbaric oxygen; pulmonary edema; risk
Abbreviations: AMI = acute myocardial infarction; atm abs = atmospheres absolute; EF = ejection fraction; FIR = heart rate; LV = left ventricular; RR = respiratory rate
Pulmonary edema is a rare complication of hyperbaric oxygen therapy.1,2 Abel et al1 estimate the incidence of pulmonary edema associated with hyperbaric oxygen therapy at 1 in 1,000, and Riddick2 suggested that patients with reduced cardiac ejection fractions (EFs; < 40%) should not receive hyperbaric oxygen therapy because of the risk of acute pulmonary edema. Details of these cases were not presented.1,2 We have observed three cases of pulmonary edema associated with hyperbaric oxygen therapy in 1,028 patients, who collectively represent 13,658 hyperbaric oxygen exposures. The etiology of pulmonary edema in patients treated with hyperbaric oxygen is unknown. The purpose of this report is to present information about these three cases, to raise awareness that selected patients treated with hyperbaric oxygen may be at risk for acute pulmonary edema, and to explore possible pathophysiologic mechanisms.
CASE REPORTS
Case 1
A 52-year-old woman with insulin-dependent diabetes mellitus for 20 years, renal insufficiency, a history of acute myocardial infarction (AMI) requiring coronary artery bypass grafting 14 years previously, and a history of acute pulmonary edema had a nonhealing ischemic plantar wound. One year earlier, her EF was 0.45 with mild-to-moderate global hypokinesis. Her pre-hyperbaric oxygen therapy heart rate (HR) was 78 beats/min, BP was 130/80 mm Hg,...