SESSION TITLE: Miscellaneous Student/Resident Case Report Posters I
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Pulmonary edema is a rare complication of hyperbaric oxygen therapy (HBOT). Riddick et al suggested that patient who have low ejection fraction should not receive hyperbaric oxygen therapy because the risk of acute pulmonary edema. This was confirmed by observational case series by Lindell et al1. We herein describe a case of pulmonary edema associated with hyperbaric oxygen therapy in patient who has normal ejection fraction (EF) with mild diastolic dysfunction.
CASE PRESENTATION: A 57-year-old male with history of obesity, sleep apnea and chronic leg ulcer, presented with acute onset difficulty breathing. During a session of HBOT, he developed acute shortness of breath associated with pink frothy sputum, tachypnea and diaphoresis. On examination, his HR 120, RR was 30 /min. He had bilateral lung crackle. His arterial blood gas sampling showed pH 7.14; PaCO2, 85; PaO2, 40. Patient was placed on BiPAP and admitted to ICU. Chest X-ray and CTA of the chest showed bilateral generalize alveolar infiltrates representing pulmonary edema. EKG showed sinus tachycardia rate 110. His EF was 60% with mild diastolic dysfunction, no wall motion abnormality. Patient was intubated for worsening hypoxia and alteration of mental status for 1 day. Patient received and responded to diuretics. Eventually, the patient was extubated and safely discharged home.
DISCUSSION: Pulmonary edema associated with HBOT is rare. Contraindication for HBOT included untreated pneumothorax, obstructive lung disease, pulmonary bleb, sinus infection, seizure disorder2,3. Generally, heart failure is not considered a risk factor in HBOT. However, our case report supports the previous opinion that acute pulmonary edema may complicate HBOT. As opposed to the previously reported case of HBOT induced pulmonary edema, our case reports the development of HBOT induced acute pulmonary edema in a patient with mild diastolic dysfunction and normal EF. Possible mechanism for HBOT causing pulmonary edema include increasing LV afterload, increasing LV filling pressure, increasing oxidative myocardial stress, increasing pulmonary capillary permeability, or causing pulmonary oxygen toxicity. Caution is recommended in treating both, low cardiac EF or diastolic dysfunction patients with HBOT.
CONCLUSIONS: Acute pulmonary edema is a rarely reported complication of HBOT. Pulmonary edema can occur in low EF heart failure patients as well as in patients with mild diastolic dysfunction and normal cardiac EF. We advise caution using HBOT not only in reduced cardiac EF but also in cardiac diastolic dysfunction patients.
Reference #1: 1. Weaver LK, Churchill S. PUlmonary edema associated with hyperbaric oxygen therapy*. CHEST Journal 2001;120:1407-9.
Reference #2: 2. Toklu AS, Korpinar S, Erelel M, Uzun G, Yildiz S. Are pulmonary bleb and bullae a contraindication for hyperbaric oxygen treatment? Respiratory Medicine 2008;102:1145-7.
Reference #3: 3. Tibbles PM, Edelsberg JS. Hyperbaric-Oxygen Therapy. New England Journal of Medicine 1996;334:1642-8.
DISCLOSURE: The following authors have nothing to disclose: Pornchai Leelasinjaroen, Nibal Saad, Wuttiporn Manatsathit, Equakhide Inegbenebor, William Ventimiglia
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