Hyperbaric Oxygen Therapy for Crush Injury
After a severe crush injury, swelling can starve the tissue of oxygen. Given early and alongside surgery, hyperbaric oxygen helps support injured-but-salvageable tissue in crush injury, compartment syndrome and other acute traumatic ischaemias.
What this means for you
What is a crush injury?
A crush injury happens when part of the body is squeezed or crushed with great force - for example in a road or industrial accident. Besides broken bones and torn tissue, the injured area swells. Because muscle sits in tight compartments, that swelling can squeeze shut the small blood vessels and cut off the oxygen supply - a problem called compartment syndrome, and part of a group of conditions called acute traumatic ischaemias.
Why does the oxygen supply matter?
Around the obviously damaged tissue there is often a border of tissue that is injured but still alive. If it does not get enough oxygen quickly, it can be lost - leading to wound problems, repeat operations, and in severe cases the risk to the limb. The aim is to protect that borderline tissue.
How can hyperbaric oxygen help?
Used early and together with surgery, hyperbaric oxygen raises the oxygen reaching the injured area and helps reduce swelling. In the chamber you breathe pure oxygen under pressure, which dissolves extra oxygen into the blood so it can reach tissue with a squeezed blood supply. This can support the borderline tissue and may lower the risk of wound complications and further surgery.
What to expect
When used for a crush injury, hyperbaric oxygen is started early and given as repeated sessions over the first days, coordinated around your operations and other treatment. Whether it is suitable depends on the type and severity of the injury 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.
Watch
Breathing Under Pressure (English)
Die Bose Kringloop (Afrikaans)
For Patients: Acute Traumatic Ischaemias (UHMS 06)This 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
Crush injury, compartment syndrome and other acute traumatic ischaemias are a recognised indication for adjunctive hyperbaric oxygen (HBO) therapy under the Undersea & Hyperbaric Medical Society (UHMS). HBO is a time-sensitive adjunct to definitive orthopaedic and vascular management - fracture stabilisation, fasciotomy and revascularisation as indicated.
Rationale
Severe traumatic ischaemia combines mechanical tissue disruption with progressive oedema, raised compartment pressures, microvascular compromise and ischaemia-reperfusion injury. As with the burn, there is a zone of marginally perfused but viable tissue whose survival depends on restoring oxygen delivery before irreversible loss occurs.
Mechanisms
HBO sharply raises plasma-dissolved oxygen, oxygenating tissue whose capillary supply is compromised by oedema. Hyperoxic vasoconstriction reduces oedema (and compartment pressures) without lowering oxygen delivery, it attenuates ischaemia-reperfusion injury by reducing neutrophil adhesion and the no-reflow phenomenon, and it supports cellular energetics and the microcirculation - collectively limiting secondary tissue loss and supporting wound healing.
Role in management
- Adjunct only, and early: benefit is greatest when started within hours; it does not replace fasciotomy, fixation or revascularisation.
- Greatest value in severe injuries (e.g. Gustilo grade III open fractures) and threatened marginal tissue.
- Coordinate with orthopaedics/vascular surgery and intensive care; manage rhabdomyolysis and renal protection in crush syndrome separately.
Treatment approach
When indicated, HBO is delivered on 100% oxygen at pressures commonly around 2.0-2.5 ATA, given more frequently in the first 24-48 hours and then reducing, over a short early course guided by clinical response. Exact pressures, durations and frequency are individualised and set case by case at the unit.
Evidence base
A randomised trial (Bouachour et al.) and supporting series report improved wound healing and fewer repeat procedures with early adjunctive HBO in severe crush injury, with benefit concentrated in the most severe injuries. It remains a recognised UHMS indication used as a time-critical adjunct.
Talks & chapter reviews
Recorded talks and textbook-chapter reviews on this indication:
UHMS Indications, Ch. 06 — Acute Traumatic Ischaemias
HMP, Ch. 26 — HBO in Crush Injury & Acute Traumatic Ischaemias
HBOT for Crush Injuries (overview)
Crush Syndrome (talk)Key references
- Moon RE (ed). Hyperbaric Oxygen Therapy Indications - Crush Injury, Compartment Syndrome and Other Acute Traumatic Ischaemias. Undersea & Hyperbaric Medical Society, 14th ed.
- Bouachour G, et al. Hyperbaric oxygen therapy in the management of crush injuries: a randomized double-blind placebo-controlled clinical trial. J Trauma. 1996.
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.