Untreated Pneumothorax

A patient presenting with an undrained pneumothorax in a pressurized hyperbaric chamber is always considered a concern. If the pneumothorax tensions at pressure, decompression will be extremely hazardous and potentially life-threatening. A patient with a pre-existing pneumothorax should have a chest tube inserted prior to pressurization, and, if a pneumothorax occurs under pressure a chest tube should be inserted prior to decompression. It is prudent to obtain a chest x-ray after the placement of a subclavian line, to rule out the occurrence of pneumothorax before a patient is pressurized in the chamber.

Doxorubivin (AdrimycinR) - Antineoplastic agent

While HBOT was being investigated as a non-surgical
“antidote” for tissue damage caused by the extravasation of Doxorubicin, it was discovered that this drug combined with HBOT caused an 87% mortality rate in lab rats. This mortality rate did not vary with reduced HBOT frequency. A patient should be discontinued from Doxorubicin at least one week prior to beginning HBOT.

Disulfiram (AntabuseR) - Antialcoholic

Disulfiram was found to block both pulmonary and central
nervous system oxygen toxicity. However, additional work revealed that the body’s superoxide dismutase (SOD) was reduced by Disulfiram. The SOD system is the body’s main defence against oxygen toxicity. Therefore, Disulfiram use is contraindicated during HBOT in all cases except Carbon Monoxide poisoning (single treatment). Patients in need of
serial HBO treatments should be discontinued from Disulfiram at least one week prior to commencing HBOT.

Cis-Platinum - Antineoplastic

Cis-Platinum is an agent that is useful in the control of a number of cancers by interfering with DNA synthesis and subsequent delays in fibroblast production and collagen synthesis. The incompatibility with HBOT occured because the wound breaking strength was found to be considerably less in the HBOT/Cis-Platinum group than in the control group. HBOT should be delayed until the patient has been discontinued from Cis-Platinum for at least one week.

Mafenide Acetate (SulfamylonR) - Antibacterial

This antibacterial cream was found useful in suppressing infection in burn patients. However, Mafenide is also a carbonic anhydrase inhibitor which tends to encourage carbon dioxide buildup that causes a peripheral vasodilator. A synergistic detrimental effect occurs when this effect is combined with the
central vasoconstriction caused by HBOT. Patients, who are being prepared for HBOT and are receiving Mafenide cream therapy, should have all of the cream removed by tubbing. Silver Sulfadiazene (FlamazineR) is an effective substitute and is compatible with HBOT.