Magnitude and Clinical Predictors of Blood Pressure Changes in Patients Undergoing Hyperbaric Oxygen Therapy: A Retrospective Study

Abstract

Hyperbaric oxygen therapy (HBOT) is widely used to treat several pathologies. The hemodynamic changes during HBOT, particularly the magnitude of arterial blood pressure (ABP) increase, are not completely understood. No clinical predictors for HBOT-induced ABP increase have been described. The purpose of this study was to quantify ABP changes in patients undergoing HBOT and to examine their predictors. This retrospective longitudinal cohort study examined 3291 elective HBOT sessions. Non-invasive ABP was recorded before and after each session. The primary outcome was to quantify the HBOT-induced ABP rise. The secondary outcome was to determine the ABP-rise predictors among demographic and clinical variables. Overall, ABP increased significantly after HBOT; this finding was more evident in the hypertensive subgroup compared to the normotensive one (+6 vs. +16.2 mmHg). Clinical predictors of significant post-HBOT ABP change were history of hypertension and pre-session baseline ABP classification. This study demonstrates an absolute HBOT-induced ABP rise. This change is clinically relevant in patients with history of hypertension. A higher baseline ABP seems a risk factor for clinically relevant ABP change. Pre-session ABP should be used clinically as an indicator for strict ABP monitoring during HBOT; future studies are recommended to explore the ABP optimization before starting an HBO treatment.

Hyperbaric oxygen therapy for healthy aging: From mechanisms to therapeutics

“…In addition to the commonly considered contraindications such as pneumothorax, special attention must be paid to some chronic conditions that frequently occur in the aging populations. For example, it is demonstrated in a retrospective study that standard HBOT protocols lead to an absolute rise in arterial blood pressure (ABP), especially in a hypertensive subgroup [ 199 ]. Since a higher baseline ABP is commonly observed in the elderly, appropriate pre-session ABP levels should be described as thresholds for strict ABP monitoring during HBOT.…”

Safety of hyperbaric oxygen therapy in patients with heart failure: A retrospective review

“…He had a history of hypertension, previous admission for heart failure, echocardiographic evidence of diastolic dysfunction, and ongoing treatment with thiazide diuretics but not loop diuretics. His consistently increased SAP and DAP post-sessions may suggest a marked increase in afterload during and after each session (15), and increased afterload is a well-known effect of HBOT which contributes to decreases in CO (6, 12). Further, there is evidence that hyperoxia increases LV end-diastolic pressure (LVEDP), and it is associated with disturbances of both early and late phases of LV filling in patients with and without HF (28).…”

“…Conventional HBOT protocols were utilized in the treatment of all patients, as previously described (15): these included the administration of 100% oxygen at 2.0 or 2.4 atmospheres 8 absolute (ATA) for 90 minutes, with 1 -2 air breaks (0.21 fraction of inspired O 2 at the same ATA) per session, five times weekly, either in a mono-place chambers (Sechrist 3600H and Sechrist 4100H, Sechrist Industries Inc., Anaheim, CA, USA; PAH-S1-3200, Pan-America Hyperbarics Inc., Plano, TX, USA; Sigma 36, Perry Baromedical, Riviera Beach, Fl, USA) or through a plastic hood in the multi-place chamber (rectangular Hyperbaric System, Fink Engineering PTY-LTD, Warana, Australia). Standard monitoring included measurements of systolic (SAP), diastolic (DAP), and mean (MAP) blood pressure (BP), heart rate (HR), and peripheral oxygen saturation (SpO2) assessed during a five-minute period preceding and following each HBOT session.…”

“…Numerous mechanisms for the effect of HBOT on CO have been suggested (13,14) although this effect predominately results from HBOT-induced vasoconstriction, the physiological protective response to extremely high arterial partial pressures of oxygen (7). These hemodynamic changes appear to be well tolerated in patients without preexisting cardiac disease (15,16). However, there is limited evidence regarding the applicability of HBOT in patients with HF and reduced ejection fraction (HFrEF) and, furthermore, no data on patients with HF with preserved ejection fraction (HFpEF) or HF with mid-range ejection fraction (HFmEF).…”

Renal Effects of Hyperbaric Oxygen Therapy in Patients with Diabetes Mellitus: A Retrospective Study

“…We did not find significant differences in urine concentration before and after HBOT, which argues that the observation of lesser proteinuria is not an artifact of dilution. The most common hemodynamic side effect of HBOT is a transient increase in blood pressure (BP), likely due to effects on nitric oxide during HBOT [ 16 ]. As the normal variation of physical activity, posture, temperature, and consequently, blood pressure is responsible for diurnal variations of proteinuria [ 17 ], one might have expected an increase in proteinuria because of increased BP with HBOT treatments.…”