Who Shouldn't Have Hyperbaric Oxygen Therapy? Contraindications and Screening Explained
Lisa St. John, M.S.
Lisa is our Clinic Director and Founder. She earned her Master's degree from Harvard University, completed a Fellowship at Stanford University, and has spent the last 30 years working in the healthcare field.
Hyperbaric oxygen therapy (HBOT) has an excellent safety record, but it isn't right for everyone. The one absolute contraindication is an untreated collapsed lung (pneumothorax). Several other conditions and medications call for extra caution or a delay. A screening with your care team before your first session is how we make sure HBOT is safe for you.
Why Screening Comes First
HBOT means breathing concentrated oxygen in a pressurized chamber. For the 14 FDA-cleared conditions, such as diabetic foot ulcers, radiation tissue injury and compromised skin grafts, it is a well-studied therapy. Because pressure and oxygen affect the lungs, ears, sinuses and brain, a short medical review is a standard first step. Think of it as a safety check before a flight: it takes a few minutes and prevents most problems.
The One Absolute Contraindication
Untreated pneumothorax (collapsed lung). Pressure changes can turn a small air pocket in the chest into a serious emergency. If you have had a pneumothorax, it must be treated, usually with a chest tube, before any HBOT. Tell us about any past lung collapse.
Conditions That Need Extra Caution
These are "relative" contraindications. They don't automatically rule you out, but your physician will weigh the benefits and risks first:
Lung disease, such as severe COPD or emphysema, where trapped air can be a concern
Cold, flu or sinus infection, which can make it hard to equalize ear pressure (we may simply reschedule)
Ear or sinus problems, including past ear surgery
High fever, which may raise seizure risk
Seizure disorders, because oxygen at pressure can rarely trigger seizures
Pregnancy, where HBOT is generally reserved for emergencies
Implanted devices, such as pacemakers or pumps, which must be cleared by the manufacturer's guidance
Claustrophobia, which is common and manageable. Ask about our tips for first-timers.
Medications to Tell Us About
A few drugs can interact with HBOT, including certain chemotherapy agents (doxorubicin, bleomycin, cisplatin), disulfiram (Antabuse) and mafenide acetate burn cream. Bring a full list of medications and supplements to your screening.
What Happens at Screening
A review of your medical history, medications and any recent illness
A check of your ears and, when needed, a chest X-ray
A conversation with your physician about your goals and whether HBOT fits
If something comes up, it's often temporary. Many patients begin treatment after an infection clears or a medication plan is adjusted.
Safety and Expert Care
At Bay Area Hyperbarics, safety comes first. Our team reviews every patient's history before treatment and monitors you throughout each session.
Consult a healthcare provider before starting any new treatment. This article is for educational purposes and does not replace medical advice from your care team.
Frequently Asked Questions
Is hyperbaric oxygen therapy safe? For appropriately screened patients, yes. Most side effects are mild, such as ear pressure or temporary fatigue.
Can I have HBOT if I have a cold? Usually not until it clears, since congestion makes pressure changes uncomfortable. We'll reschedule.
Can I do HBOT with a pacemaker? Sometimes. It depends on the device model, so we check the manufacturer's guidance first.
Can I do HBOT if I have asthma or COPD? Often yes, with physician review. Severe lung disease needs closer evaluation.
Is HBOT safe during pregnancy? It is generally reserved for emergencies such as carbon monoxide poisoning. Talk to your OB and our physician first.
Not sure whether HBOT is a fit for you? Call our team for a screening conversation.
