HBOT use, its side effects, precautions, and contraindications (modified after [1317])

Therapeutic benefitsPrecautions needed*Absolute contraindicationsSide effects

Decompression sickness**

Arterial gas embolism**

Carbon monoxide poisoning and smoke inhalation**

Wound healing (i.e. burns, fractures)**

Anemia (severe anemia when blood transfusions cannot be used)**

Crush injury**

Gas gangrene**

Radiation injury**

Idiopathic (sudden sensorineural) hearing loss**

Sudden and painless vision loss in one eye due to blockage of blood flow**

Severe skin graft flap at risk of tissue death**

Infections due to antibiotic resistant bacteria (soft tissue infections**, osteomyelitis**, necrotizing fasciitis, infective endocarditis)

Autoimmune illnesses (multiple sclerosis, type 1 diabetes, rheumatoid arthritis, psoriasis/psoriatic arthritis and psoriasis vulgaris, systemic lupus erythematosus and associated acute macular neuroretinopathy, inflammatory bowel disease, and Hashimoto’s thyroiditis)

Long COVID

Brain abscess

Traumatic brain injury and concussion

Fibromyalgia

Brain fog

Addiction

Cerebral palsy

Alopecia

HIV

Migraine

Sports injuries

Stroke

Mental health diseases [i.e. post-traumatic stress disease, obsessive-compulsive disorder, autism spectrum disorder, mood disorder (i.e. depression, postpartum depression, bipolar disorder, premenstrual mood disorder), anxiety (including adjustment disorder with anxiety, panic disorder, social anxiety), schizophrenia (including schizoaffective disorder)

Dementia

Recent ear surgery or injury

Cold or fever

Uncontrolled hypertension

Uncontrolled diabetes

Certain types of lung disease may increase the risk of getting a collapsed lung (i.e. COPD, cystic fibrosis, and emphysema)

Caution required for concurrent use of:

doxorubicin (increasing doxorubicin-mediated cardiotoxicity; drug should be stopped 24 h before HBOT);

disulfiram (by blocking superoxide dismutase) can increase the risk of oxygen toxicity, and result in seizures and pulmonary toxicity. The recommendation is not to use concurrently disulfiram with HBOT;

cisplatin, a chemotherapy drug used to treat testicular, ovarian, bladder, head and neck, lung, and cervical cancer, with HBOT is a relative contraindication since cisplatin can impair wound healing and make the treatment futile;

mafenide (a sulfonamide-type medication used as an antibiotic) can cause carbon dioxide production leading to acidosis

Untreated pneumothorax

Restrictive airway disorders

Simultaneous chemotherapy

Use of bleomycin (distant use of bleomycin, > 6 months, is required). Pre-treatment evaluation with a physical examination, radiography, blood gas, and spirometry is necessary to determine if HBOT is safe

Temporary fatigue (due to the body adapting to enhanced oxygen saturation)

Barotrumatic lesions

Oxygen toxicity

Confinement anxiety

Claustrophobia

Trauma to the middle ear

Eye damage

Lung collapse

Low blood sugar

Sinus problems (i.e. a runny or stuffy nose, mucus drainage, a sinus headache)

Transient nearsightedness

Seizures (convulsions, sensory disturbances, and fainting)

COPD: chronic obstructive pulmonary disease; *: Advice to postpone a therapy session based on a current health situation; **: US Food and Drug Administration (FDA) approved HBOT treatments [17]