[Pneumothorax during hyperbaric oxygenation].

BACKGROUND

Tension pneumothorax is an absolute contraindication to hyperbaric oxygenation (HBO). During the decompression, at the end of the hyperbaric session, the increase in gas volume related to decreasing the pressure in the chamber can induce tension pneumothorax. The risk can be minimised, when pleural cavities have been drained before the session.

CASE REPORT

A 13-year-old girl was admitted to the Hyperbaric Intensive Therapy Unit after carbon monoxide poisoning and subsequent drowning in a bath and cardiac arrest. She was resuscitated at the site of the accident and transferred to the hyperbaric centre. On admission, she was deeply unconscious, hypothermic, her GCS was 3, and her pupils were non-reacting and maximally dilated. COHb concentration was 48.7%, and X-ray revealed pulmonary oedema. She arrested again and HBO was started during CPR. After 30 min, spontaneous circulation returned and her COHb concentration decreased to 25.6%. During the next 6 h, COHb decreased to 6.5%. The patient developed severe ARDS, and HBO sessions were continued. During the fourth session, the HBO team became aware of an earlier chest x-ray showing a left-sided tension pneumothorax. Emergency decompression was attempted, but it resulted in rapid enlargement of the pneumothorax and deterioration in the patient's condition. The pressure in the chamber was immediately increased and a thoracic drain inserted by the attending anaesthesiologist. Further decompression was uneventful.Despite intensive treatment, the girl died after 85 h of treatment because of severe ARDS.

DISCUSSION

Despite initial successful resuscitation, the girl died, primarily due to severe ARDS that was probably related to the near-drowning and repeated CPR. In such cases it is essential to be able to react quickly inside the chamber and an attending anaesthesiologist should be always present in the chamber during HBO sessions.