Ulus Travma Acil Cerrahi Derg. 2025; 31(9): 854-859 | DOI: 10.14744/tjtes.2025.24187

Hyperbaric oxygen therapy in patients with thoracic injuries: Is it safe?

Kübra Canarslan Demir¹, Ahmet Uður Avcý², Münire Kübra Özgök Kangal¹, Gözde Büþra Sarýyerli Dursun³, Gamze Aydýn², Taylan Zaman¹, Þahin Kaymak^4
1Department of Underwater and Hyperbaric Medicine, Gülhane Faculty of Medicine, University of Health Sciences, Ankara-Türkiye
²Department of Aerospace Medicine, Gülhane Training and Research Hospital, University of Health Sciences, Ankara-Türkiye
³Department of General Surgery, Gülhane Faculty of Medicine, University of Health Sciences, Ankara-Türkiye
⁴Department of General Surgery, Gülhane Faculty of Medicine, University of Health Sciences, Ankara, Türkiye

BACKGROUND: This retrospective cohort study aimed to evaluate the safety of hyperbaric oxygen therapy (HBOT) in patients with blunt thoracic trauma, with particular focus on crush injuries sustained during the 2023 Kahramanmaraþ earthquakes.
METHODS: Twenty-five patients with documented thoracic trauma who underwent HBOT at a tertiary care center were included. HBOT was delivered at 2.4 atmospheres absolute (ATA) for two hours per session in a multiplace chamber. Data on demographics, clinical findings, treatment outcomes, and adverse events were analyzed.
RESULTS: The median age was 23 years (range: 10-57), and 64% were female. The median number of HBOT sessions was 11 (range: 2-37). Three patients (12%) died during follow-up due to severe crush injuries, unrelated to HBOT. Five patients (20%) developed respiratory or cardiac symptoms during treatment, including dyspnea (n=2), chest pain (n=1), dyspnea with chest pain (n=1), and arrhythmia with convulsions (n=1). Pneumomediastinum was incidentally detected in one intubated patient post-session and was managed conservatively, allowing HBOT to continue without further complications. One patient experienced a generalized seizure attributed to central nervous system oxygen toxicity; HBOT was discontinued, neurological evaluation was performed, and no permanent sequelae occurred.
CONCLUSION: Although HBOT is generally considered safe, it may cause cardiopulmonary complications in patients with thoracic trauma, especially those with poor clinical reserve or requiring mechanical ventilation. Most complications observed in this cohort were minor and manageable. HBOT can be safely administered in carefully selected thoracic trauma patients when individualized risk assessment and multidisciplinary monitoring are ensured. Future prospective studies with larger cohorts are needed to further clarify safety profiles and risk stratification strategies.

Keywords: Hyperbaric oxygen therapy, thoracic trauma, blunt chest injury, pulmonary complications.

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Toraks yaralanmasý olan hastalarda hiperbarik oksijen tedavisi: Güvenli mi?

Kübra Canarslan Demir¹, Ahmet Uður Avcý², Münire Kübra Özgök Kangal¹, Gözde Büþra Sarýyerli Dursun³, Gamze Aydýn², Taylan Zaman¹, Þahin Kaymak^4
1SBÜ Gülhane Týp Fakültesi, Su Altý Hekimliði ve Hiperbarik Týp Anabilim Dalý, Ankara, Türkiye
²SBÜ Gülhane Eðitim ve Araþtýrma Hastanesi, Hava ve Uzay Hekimliði
³SBÜ Gülhane Eðitim ve Araþtýrma Hastanesi, Su Altý Hekimliði ve Hiperbarik Týp Anabilim Dalý, Ankara, Türkiye
⁴SBÜ Gülhane Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ankara, Türkiye

AMAÇ: Bu retrospektif kohort çalýþmada, 2023 Kahramanmaraþ depremleri sonrasýnda künt toraks travmasý geçiren hastalarda hiperbarik oksijen tedavisinin (HBOT) güvenliðini deðerlendirmek amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Çalýþmaya, toraks travmasý tanýsý alarak Gülhane Eðitim ve Araþtýrma Hastanesi Hiperbarik Týp Kliniði’nde HBOT uygulanan 25 hasta alýndý. HBOT, çok kiþilik bir odada 2.4 ATA basýnçta, günde bir kez, iki saat süreyle uygulandý. Hastalarýn demografik verileri, klinik endikasyonlarý, seans sayýlarý ve tedavi sýrasýnda geliþen komplikasyonlar retrospektif olarak analiz edildi.
BULGULAR: Hastalarýn medyan yaþý 23 (daðýlým: 10–57) olup, %64’ü kadýndý. Medyan HBOT seans sayýsý 11 (2–37) idi. Üç hasta (%12), HBOT tamamlandýktan sonraki takip sürecinde, altta yatan aðýr crush yaralanmalarýna baðlý olarak hayatýný kaybetmiþtir; bu ölümler HBOT ile iliþkili bulunmamýþtýr. Tedavi sýrasýnda beþ hastada (%20) solunum ve kardiyak semptomlar gözlenmiþtir: Dispne (n=2), göðüs aðrýsý (n=1), hem dispne hem aðrý (n=1), aritmi ve konvülsiyon (n=1). Bir entübe hastada seans sonrasý rutin çekilen toraks BT’de tesadüfen pnömomediastinum saptanmýþ, hasta stabil seyretmiþ ve tedaviye komplikasyonsuz þekilde devam edilmiþtir. Ayrýca bir hastada seans sýrasýnda jeneralize tonik-klonik nöbet geliþmiþ, santral sinir sistemi oksijen toksisitesine baðlý olabileceði düþünülerek HBOT sonlandýrýlmýþ ve hasta nörolojik açýdan deðerlendirilmiþtir.
SONUÇ: HBOT, toraks travmasý olan hastalarda potansiyel faydalar saðlayabilecek destekleyici bir tedavi seçeneðidir. Ancak özellikle solunum rezervi kýsýtlý, entübe edilen ya da ciddi eþlik eden yaralanmalarý bulunan hastalarda komplikasyon riski artabilir. Bu nedenle, tedavi kararý hasta bazýnda dikkatle deðerlendirilmelidir. HBOT'nin bu özel hasta grubunda uygulanabilirliðini artýrmak için multidisipliner yaklaþým, bireyselleþtirilmiþ risk analizi ve yakýn klinik izlem gereklidir.

Anahtar Kelimeler: Hiperbarik oksijen tedavisi, toraks travmalarý, künt toraks yaralanmalarý, pulmoner komplikasyonlar.

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