HBOT Contraindications: When Not to Put a Patient in the Chamber

Why screening matters

HBOT is safe for most adults, but pressure changes can be dangerous in specific conditions. A 2-minute screening questionnaire before the first session catches almost every contraindication.

Absolute contraindications (do not treat)

• Untreated pneumothorax — pressure changes can expand it. This is the one absolute medical red line.
• Severe COPD with CO2 retention — oxygen can suppress respiratory drive.
• Recent ear or sinus surgery — wait until healed.
• Untreated high fever.

Relative contraindications (use judgment)

• Pregnancy — usually safe, but document and consult.
• Seizure history — HBOT can lower seizure threshold in some patients.
• Cold, sinus congestion, ear infection — wait until clear; equalizing pressure will be painful.
• History of chest surgery or pleural disease.
• Current chemotherapy — consult the oncologist.

The pre-session checklist

• Has the patient had a chest cold or ear infection today?
• Any history of pneumothorax or lung collapse?
• Any new medications (especially doxorubicin, disulfiram, mafenide)?
• Remove watches, phones, lighters, oils, cosmetics and synthetic fabrics.
• Patient can equalize ears (Valsalva) before starting.

When in doubt, pause and consult. A delayed session costs you an hour; a wrong session costs a patient.