Pulmonary edema associated with hyperbaric oxygen therapy

We report three cases of pulmonary edema associated with hyperbaric oxygen therapy, including one fatality. All three patients had cardiac disease and reduced left ventricular (LV) ejection fractions (EFs). Two patients had d iabetes, and one patient had severe aortic stenosis. Hyperbaric oxygen ther apy may contribute to pulmonary edema by increasing LV afterload, increasin g LV filling pressures, increasing oxidative myocardial stress, decreasing LV compliance by oxygen radical-mediated reduction in nitric oxide, alterin g cardiac output between the right and left hearts, inducing bradycardia wi th concomitant LV dysfunction, increasing pulmonary capillary permeability, or by causing pulmonary oxygen toxicity. We advise caution in the use of h yperbaric oxygen therapy in patients with heart failure or in patients with reduced cardiac EFs.