Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada.
Hyperbaric Medicine Unit, Toronto General Hospital, Toronto, ON, Canada.
PLoS One. 2024 Feb 8;19(2):e0293484. doi: 10.1371/journal.pone.0293484. eCollection 2024.
Hyperbaric oxygen therapy (HBOT) has several hemodynamic effects including increases in afterload (due to vasoconstriction) and decreases in cardiac output. This, along with rare reports of pulmonary edema during emergency treatment, has led providers to consider HBOT relatively contraindicated in patients with reduced left ventricular ejection fraction (LVEF). However, there is limited evidence regarding the safety of elective HBOT in patients with heart failure (HF), and no existing reports of complications among patients with HF and preserved LVEF. We aimed to retrospectively review patients with preexisting diagnoses of HF who underwent elective HBOT, to analyze HBOT-related acute HF complications.
Research Ethics Board approvals were received to retrospectively review patient charts. Patients with a history of HF with either preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmEF), or reduced ejection fraction (HFrEF) who underwent elective HBOT at two Hyperbaric Centers (Toronto General Hospital, Rouge Valley Hyperbaric Medical Centre) between June 2018 and December 2020 were reviewed.
Twenty-three patients with a history of HF underwent HBOT, completing an average of 39 (range 6-62) consecutive sessions at 2.0 atmospheres absolute (ATA) (n = 11) or at 2.4 ATA (n = 12); only two patients received fewer than 10 sessions. Thirteen patients had HFpEF (mean LVEF 55 ± 7%), and seven patients had HFrEF (mean LVEF 35 ± 8%) as well as concomitantly decreased right ventricle function (n = 5), moderate/severe tricuspid regurgitation (n = 3), or pulmonary hypertension (n = 5). The remaining three patients had HFmEF (mean LVEF 44 ± 4%). All but one patient was receiving fluid balance therapy either with loop diuretics or dialysis. Twenty-one patients completed HBOT without complications. We observed symptoms consistent with HBOT-related HF exacerbation in two patients. One patient with HFrEF (LVEF 24%) developed dyspnea attributed to pulmonary edema after the fourth treatment, and later admitted to voluntarily holding his diuretics before the session. He was managed with increased oral diuretics as an outpatient, and ultimately completed a course of 33 HBOT sessions uneventfully. Another patient with HFpEF (LVEF 64%) developed dyspnea and desaturation after six sessions, requiring hospital admission. Acute coronary ischemia and pulmonary embolism were ruled out, and an elevated BNP and normal LVEF on echocardiogram confirmed a diagnosis of pulmonary edema in the context of HFpEF. Symptoms subsided after diuretic treatment and the patient was discharged home in stable condition, but elected not to resume HBOT.
Patients with HF, including HFpEF, may develop HF symptoms during HBOT and warrant ongoing surveillance. However, these patients can receive HBOT safely after optimization of HF therapy and fluid restriction.
高压氧治疗（HBOT）具有多种血液动力学效应，包括后负荷增加（由于血管收缩）和心输出量减少。由于在紧急治疗期间罕见肺水肿的报道，这导致提供者认为 HBOT 在左心室射血分数（LVEF）降低的患者中相对禁忌。然而，关于心力衰竭（HF）患者中选择性 HBOT 的安全性的证据有限，并且在 HF 和保留 LVEF 的患者中没有关于并发症的现有报告。我们旨在回顾既往诊断为 HF 的患者，分析与选择性 HBOT 相关的急性 HF 并发症。
获得研究伦理委员会批准，回顾性审查患者图表。在 2018 年 6 月至 2020 年 12 月期间，在多伦多总医院和 Rouge Valley 高压医疗中心的两个高压中心接受选择性 HBOT 的既往诊断为 HF 且射血分数保留（HFpEF）、中范围射血分数（HFmEF）或射血分数降低（HFrEF）的患者接受了审查。
23 名既往有 HF 病史的患者接受了 HBOT，在 2.0 绝对大气压（ATA）（n = 11）或 2.4 ATA（n = 12）下完成了平均 39 次（范围 6-62 次）连续治疗；只有两名患者接受的治疗次数少于 10 次。13 名患者有 HFpEF（平均 LVEF 55 ± 7%），7 名患者有 HFrEF（平均 LVEF 35 ± 8%），同时伴有右心室功能下降（n = 5）、中度/重度三尖瓣反流（n = 3）或肺动脉高压（n = 5）。其余 3 名患者有 HFmEF（平均 LVEF 44 ± 4%）。除一名患者外，所有患者均接受利尿剂或透析的液体平衡治疗。21 名患者在没有并发症的情况下完成了 HBOT。我们观察到两名患者的症状与 HBOT 相关的 HF 恶化一致。一名 HFrEF（LVEF 24%）患者在第四次治疗后出现呼吸困难，归因于肺水肿，后来在治疗前自愿停止使用利尿剂。他在门诊接受了增加口服利尿剂的治疗，最终成功完成了 33 次 HBOT 治疗。另一名 HFpEF（LVEF 64%）患者在 6 次治疗后出现呼吸困难和缺氧，需要住院治疗。排除急性冠状动脉缺血和肺栓塞，BNP 升高和超声心动图上正常的 LVEF 证实 HFpEF 背景下的肺水肿诊断。利尿剂治疗后症状缓解，患者情况稳定出院，但决定不再接受 HBOT。
HF 患者，包括 HFpEF，在 HBOT 期间可能会出现 HF 症状，需要持续监测。然而，在 HF 治疗和液体限制优化后，这些患者可以安全地接受 HBOT。
