Schiavo S, Brenna CTA, Bhatia A, Middleton WJ, Katznelson R, et al.
International journal of environmental research and public health. Date of publication 2023 May 1;volume 20(9):.
1. Int J Environ Res Public Health. 2023 May 1;20(9):5693. doi:
10.3390/ijerph20095693.
Clinical Considerations for Implanted Neurological Devices in Patients
Undergoing Hyperbaric Oxygen Therapy: A Case Report and Review of Manufacturer
Guidelines.
Schiavo S(1)(2)(3), Brenna CTA(1), Bhatia A(1)(3), Middleton WJ(1)(2)(3),
Katznelson R(1)(2)(3).
Author information:
(1)Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto,
ON M5G 1E2, Canada.
(2)Hyperbaric Medicine Unit, Toronto General Hospital, Toronto, ON M5G 2C4,
Canada.
(3)Department of Anesthesia and Pain Management, University Health Network,
Toronto, ON M5G 2C4, Canada.
Patients with implanted medical devices are increasingly referred for hyperbaric
oxygen therapy (HBOT), and the safety of exposing some of these devices to
hyperbaric environments has not previously been explored. There is a paucity of
evidence surrounding the management of implanted neurological devices such as
neurostimulators and intrathecal drug delivery (IDD) pumps in the context of
HBOT. However, these devices can be expected to harbor unique risks; for
example, vacant space in the reservoir of an implanted IDD pump may change in
pressure and volume during the compression and decompression phases of HBOT,
resulting in a damaged or dysfunctional device. We present the case of a
27-year-old woman with cerebral palsy referred for HBOT to manage a necrotizing
soft tissue infection cultured from a dehiscent abdominal wound at the previous
implantation site of an intrathecal baclofen pump. An HBOT protocol was
ultimately chosen in partnership with the patient and her family, but treatment
was not performed due to a paucity of evidence that the implanted IDD pump could
safely withstand hyperbaric exposure. In this review, we have synthesized
manufacturer recommendations regarding the management of implanted neurological
devices before, during, and after HBOT to inform future decision-making in this
setting. Among these recommendations, we highlight that neurostimulators should
be switched off for the duration of HBOT and implanted pumps should be refilled
prior to each treatment session to minimize empty reservoir space.
DOI: 10.3390/ijerph20095693
PMCID: PMC10177826
PMID: 37174212 [Indexed for MEDLINE]
Conflict of interest statement: Anuj Bhatia’s Institution (University Health
Network, Toronto, Canada) has received funding from Medtronic and Abbott for
performing research. Anuj Bhatia has received honoraria as a consultant from
Medtronic and Bioventus.
