Hyperbaric oxygen therapy in orthopedic conditions: an evaluation of safety.
BACKGROUND
Because of the documented cellular and biochemical benefits of hyperbaric oxygen (HBO), HBO therapy is applied now with increasing frequency to various orthopedic conditions. Many traumatologists and orthopedic surgeons might refer their patients for adjuvant HBO therapy. However, the potential risks and risk-benefit ratio have often been underemphasized in therapeutic trials.


METHODS
From October 2002 to September 2004, 240 patients with a total of 4,638 treatments received HBO therapy at the hyperbaric medicine center of our institution on an identical treatment protocol. HBO therapy patient treatment logs were reviewed to analyze the incidence of complications during HBO treatment.


RESULTS
The overall incidence of complications was 1.83%. Over 94% of treatment complications were mild to moderate and designated as minor complications; fewer than 6% were severe or life threatening and designated as major complications. The incidence of major complications (central nervous system [CNS] oxygen toxicity in this series) was 0.109%. There was no mortality. Two patients with unusual presentation of CNS oxygen toxicity were observed during the study period.


CONCLUSIONS
HBO therapy in orthopedic conditions is considered as a safe treatment because of a very low complication rate; however, analysis of patients with CNS oxygen toxicity revealed its unpredictability and inevitability. Although it is common sense that patients who develop a seizure in the hospital need help from the medical staff, it cannot be done in a monoplace hyperbaric chamber because of pressure unequalization. Therefore, a multiplace chamber equipped with an antechamber for medical contingency is possibly the better facility in consideration of safety.
Huang
Kuo-Chin
KC
Department of Orthopaedics, Chang Gung Memorial Hospital at Chia-Yi, Taiwan. kc2672@adm.cgmh.org.tw
Hsu
Wei-Hsiu
WH
Peng
Kuo-Ti
KT
Huang
Tsung-Jen
TJ
Hsu
Robert Wen-Wei
RW
D000328:Adult; D000368:Aged; D000648:Amnesia, Retrograde / Q000209:etiology; D001273:Atmosphere Exposure Chambers; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods*; D018570:Risk Assessment; D012449:Safety; D013226:Status Epilepticus / Q000209:etiology*