Medical/Patient Care
Questions pertaining to medical or patient care
Any contraindication treating patient with patent foramen ovale?
Posted: 5/25/23
Q: Any contraindication treating patient with patent foramen ovale?
A: In the general population 30% of individuals have a PFO. Individuals with a PFO have a slightly increased risk of decompression sickness (DCS). However, the risk of DCS for a patient undergoing hyperbaric oxygen treatment is zero. Thus, for patients undergoing HBO2 treatment the presence of a PFO is irrelevant.
What is the main concern or danger with a systolic blood pressure below 100 pre HBO treatment assessment?
Posted:11/13/23
Q:
What is the main concern or danger with a systolic blood pressure below 100 pre HBO treatment assessment?
A:
There is nothing magic about a systolic BP less than 100mmHg in the hyperbaric environment. Various authors have studied the impact of BP as the result of hyperbaric treatments. We know that HBO2 causes arteriolar constrictions and increased afterload, sometimes leading to the occurrence or worsening of CHF. For most patients, the changes are negligible. But for a patient with hypotension in the chamber, the tendency is for a BP increase not a decrease.
I am not sure where you got this guidance. I would like to know for future reference. The thinking, I believe, arises out of caution because 100 mmHg systolic is a fairly low pressure and may be due to sepsis or blood loss. More than anything, I believe whoever authored this policy was trying to alert the treating HBO2 doctor that the patient may be having significant intercurrent disease symptoms and should be stabilized before going into the chamber.
There is a subset of slight young women who characteristically will run blood pressures like this. It is therefore important to get the patient’s history or check previous medical trecords to determine if this is a normal and usual pressure for your patient.
John J. Feldmeier, D.O.
Does a patients A1C need to be below a certain number before HBO tx is beneficial?
Posted: 6/20/24
Q: Does a patients A1C need to be below a certain number before HBO tx is beneficial?
A:
No. The question is if the email is referencing the wound care literature, which is split between those who feel better control equates to better outcomes and those who believe that all patients deserve a trial.
If the question is referencing the requirement for DFU and HBOT, then the question is more about documenting an A1C and then referring them to a nutritionist/PCP for counseling and intervention. There is a schism even within the diabetes community as to what constitutes good control; it varies depending upon the age of the patient and the co-morbidities.
https://diabetesjournals.org/care/article/46/Supplement_1/S216/148044/13-Older-Adults-Standards-of-Care-in-Diabetes-2023
Whether or not they have significant autonomic dysfunction and can sense hypoglycemia is a major risk factor that needs to be addressed.
There are multiple examples in the literature where A1C and outcomes are not linked in the hyperbaric medicine space.
Helen Gelly, MD, FUHM, FACCWS, UHM/ABPM
Thank you.