Investigation of prophylactic paracentesis (PC) to avoid barotrauma during hyperbaric oxygen therapy (HBOT)
23 April 2019 (online)
Barotrauma (BT) occurs in 14 – 43% of HBOTs performed. Patients with artificial airway or eustachian tube dysfunction have an increased risk of developing BT. It is difficult to predict the occurrence of BT. There are no published data on the prophylactic use of therapeutic options (e.g. PC). For this reason, we asked ourselves whether a PC in V.a. tube dysfunction or patients in ITN is useful to avoid BT.
Retrospectively, all patients who received an emergency HBOT in the period 01/2017 – 12/2017 in the University Hospital Düsseldorf were recorded with regard to anamnesis, otoscopy, Valsalva, tympanogram before HBO and after the occurrence of BT.
A total of 149 patients received an emergency HBOT during the above mentioned period. 23 patients received a PC (15%), 19 of them prophylactically and 4 after BT. 10 of the 19 prophylactic PCs were given to intubated patients. In 9 patients, the indication for PC was given on the basis of the clinical examination: 9/9 patients had a negative valsalva, 3/9 additionally a flat tympanogram and 2/9 a conspicuous otoscopy. 4 patients suffered a BT (2.6%) despite an inconspicuous ENT examination, 2 patients had a conspicuous anamnesis regarding the tube function. 6 patients were able to tolerate HBOT despite negative valsalvas.
A prophylactic PC when there ist no possibility of pressure equalization seems to be an effective procedure to reduce the occurrence of BT. However, it seems reasonable to develop further criteria, e.g. within the scope of a scoring system, in order to prevent BT or avoid unnecessary operations.