Hyperbaric oxygen therapy in patients with thoracic injuries: Is it safe?

Background: This retrospective cohort study aimed to evaluate the safety of hyperbaric oxygen therapy (HBOT) in patients with blunt thoracic trauma, with particular focus on crush injuries sustained during the 2023 Kahramanmaraş earthquakes.

Methods: Twenty-five patients with documented thoracic trauma who underwent HBOT at a tertiary care center were included. HBOT was delivered at 2.4 atmospheres absolute (ATA) for two hours per session in a multiplace chamber. Data on demographics, clinical findings, treatment outcomes, and adverse events were analyzed.

Results: The median age was 23 years (range: 10-57), and 64% were female. The median number of HBOT sessions was 11 (range: 2-37). Three patients (12%) died during follow-up due to severe crush injuries, unrelated to HBOT. Five patients (20%) developed respiratory or cardiac symptoms during treatment, including dyspnea (n=2), chest pain (n=1), dyspnea with chest pain (n=1), and arrhythmia with convulsions (n=1). Pneumomediastinum was incidentally detected in one intubated patient post-session and was managed conservatively, allowing HBOT to continue without further complications. One patient experienced a generalized seizure attributed to central nervous system oxygen toxicity; HBOT was discontinued, neurological evaluation was performed, and no permanent sequelae occurred.

Conclusion: Although HBOT is generally considered safe, it may cause cardiopulmonary complications in patients with thoracic trauma, especially those with poor clinical reserve or requiring mechanical ventilation. Most complications observed in this cohort were minor and manageable. HBOT can be safely administered in carefully selected thoracic trauma patients when individualized risk assessment and multidisciplinary monitoring are ensured. Future prospective studies with larger cohorts are needed to further clarify safety profiles and risk stratification strategies.