Hyperbaric Oxygen Therapy for Acute Thermal Burns
In serious burns, hyperbaric oxygen is used as an adjunct to standard burn care - to help reduce swelling, support injured-but-salvageable tissue, and aid healing.
What this means for you
How burns injure tissue
A burn injures the skin and the tissue beneath it. Around the obviously destroyed area there is often a surrounding zone that is injured but not yet dead - sometimes called the "zone of stasis". In the hours and days after a burn, swelling and poor blood flow can tip that borderline tissue over into permanent damage, making the wound deeper and larger.
Where does hyperbaric oxygen fit in?
The foundation of burn treatment is specialist care: fluids, careful wound dressing, infection control and, when needed, surgery and skin grafting. Hyperbaric oxygen is used as an add-on in selected serious burns - never as a replacement for that care. By raising the oxygen reaching the injured area, it may help reduce swelling and support the borderline tissue so that less of it is lost.
What to expect
When hyperbaric oxygen is used for a burn it is started early and given as repeated sessions, carefully coordinated with the burns unit and fitted around dressing changes and any operations. Whether it is suitable depends on the size, depth and site of the burn and your overall condition.
Is it safe?
Hyperbaric oxygen is generally well tolerated. The most common sensation is pressure on the ears during compression, much like descending in an aeroplane. Serious side effects are uncommon. You can read more on our risks and side effects page.
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Hyperbaric Oxygen for Burns (English)
Veg Vuur met Lug (Afrikaans)
For Patients: Thermal Burns (UHMS 14)
Thermal Burns — ExplainerThis page is general health information and does not replace advice from your own doctor. Whether hyperbaric oxygen is appropriate depends on your individual circumstances.
Clinical summary
Indication
Serious thermal burns are listed among the indications for hyperbaric oxygen (HBO) therapy by the Undersea & Hyperbaric Medical Society (UHMS), where HBO is positioned as an adjunct to comprehensive burn care. It is not a substitute for resuscitation, wound management or surgery, and patient selection matters.
Rationale
The burn wound comprises Jackson's zones of coagulation, stasis and hyperaemia. The zone of stasis is potentially salvageable but vulnerable to progression from oedema, microvascular compromise, ischaemia-reperfusion injury and infection. The therapeutic aim of adjunctive HBO is to interrupt this secondary progression.
Proposed mechanisms
HBO markedly raises dissolved oxygen to ischaemic tissue, supports the zone of stasis, promotes vasoconstriction that reduces oedema without compromising oxygenation, preserves cellular energetics and the microcirculation, attenuates lipid peroxidation and leukocyte-mediated reperfusion injury, supports fibroblast function and angiogenesis, and augments antibacterial defences. The intended effect is reduced conversion of partial- to full-thickness injury and support of graft/wound healing.
Role in management
- HBO is integrated with - and never delays - fluid resuscitation, escharotomy/excision, grafting and infection control.
- Best considered early for selected deep partial-thickness or large burns; coordinated with the burns unit and intensive-care needs.
- Airway, ventilation and concurrent inhalational injury (including carbon monoxide) must be addressed and may themselves be indications for oxygen therapy.
Treatment approach
When used, HBO is delivered on 100% oxygen at pressures commonly in the 2.0-2.4 ATA range, started early and given as repeated daily sessions over the acute period; exact pressure, duration and frequency are individualised to the burn and the patient and set case by case at the unit.
Evidence base
The evidence for HBO in thermal burns is mixed: a sound experimental and physiological rationale supports it, but randomised clinical data are limited and not uniformly positive. It is therefore offered as a selective adjunct with realistic expectations, within a comprehensive burn-care pathway.
Talks & chapter reviews
Recorded talks and textbook-chapter reviews on this indication:
UHMS Indications, Ch. 14 — Thermal Burns
HMP, Ch. 31 — Adjunctive HBOT in Thermal Burns
Adjunctive HBO in Thermal Burns (talk)
HBOT — Acute Thermal Burns (overview)Key references
- Moon RE (ed). Hyperbaric Oxygen Therapy Indications - Thermal Burns. Undersea & Hyperbaric Medical Society, 14th ed.
- Cianci P, Slade JB, Sato RM, Faulkner J. Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns. Undersea Hyperb Med.
- ISBI Practice Guidelines for Burn Care. Burns.
Speak to the unit
The Vascular & Hyperbaric Unit, Life Eugene Marais Hospital, Pretoria.
Call 012 335 8651► Browse all Educational Hyperbaric Oxygen Therapy Videos
Medically reviewed by Dr Gregory Weir, vascular surgeon. Last updated June 2026.