Description

Schmitz G. Tension Pneumothorax During Hyperbaric Oxygen Therapy With Pigtail Pleural

Catheter: A Case Report and Experimental Flow Analysis. Undersea Hyperb Med. 2026 Second

Quarter; 53(2):255-260.

Introduction: Tension pneumothorax is a life-threatening complication during hyperbaric oxygen

treatment (HBO2). The presence of a pleural catheter is assumed to mitigate this risk, but its efficiency

under hyperbaric conditions remains unclear.

Case Report: We describe a 37-year-old female undergoing HBO2 with a pigtail pleural catheter in situ

for secondary pneumothorax. The patient developed respiratory and cardiovascular symptoms during

decompression.

To investigate gas flow dynamics, we conducted an experimental analysis measuring flow resistance in

pigtail catheters under chamber pressures up to a chamber gauge pressure of 172.37 kPa. Flow rates were

analyzed across a range of differential pressures and catheter fenestration numbers.

Gas flow increased non-linearly with pressure but plateaued at higher differentials, indicating drainage

limitations. Catheters with fewer fenestrations exhibited significantly reduced flow rates. Under simulated

HBO2 conditions, pressure differentials exceeding 2.4 kPa resulted in delayed gas evacuation, mirroring

the clinical event.

Discussion: This case and experimental study highlight the potential risk of inadequate pneumothorax

drainage with pigtail catheters during HBO2. We recommend decompression rates ≤1 psi/min to mitigate

this risk. Further studies are needed to evaluate alternative catheter designs for hyperbaric environments.

Keywords: gas flow resistance; hyperbaric oxygen treatment; pleural catheter; pneumothorax; tension

pneumothorax