Hyperbaric Oxygen Therapy — UHMS Indications Repository

Indication / topic	Status	Society grade	n
Air or Gas Embolism	UHMS	UHMS-approved (primary therapy) · ECHM Type 1 · SAUHMA Level C	1
Decompression Sickness	UHMS	UHMS-approved (primary therapy) · ECHM Type 1 · SAUHMA Level C	1
Carbon Monoxide Poisoning	UHMS	UHMS-approved · SAUHMA Level A (pivotal RCT positive; two RCTs null — contested)	5
Gas Gangrene (Clostridial Myonecrosis)	UHMS	UHMS-approved (adjunct) · SAUHMA Level C	1
Necrotizing Soft Tissue Infections	UHMS	UHMS-approved (adjunct) · SAUHMA Level C	1
Crush Injury & Acute Traumatic Ischemia	UHMS	UHMS-approved (adjunct) · SAUHMA Level B (Bouachour RCT)	1
Central Retinal Artery Occlusion	UHMS	UHMS-approved · AHA/UHMS Class IIb · time-critical (<24 h)	2
Severe Anemia	UHMS	UHMS-approved (exceptional blood-loss anaemia) · bridge therapy · AHA Class IIb	1
Intracranial Abscess	UHMS	UHMS-approved (adjunct to neurosurgery + antibiotics) · cohort-level evidence	1
Problem Wounds (Diabetic Foot & Arterial Insufficiency)	UHMS	UHMS-approved (selected problem wounds) · SAUHMA Level B · RCTs mixed	10
Compromised Grafts & Flaps	UHMS	UHMS-approved (salvage) · UHMS class IB (Perrins RCT)	1
Refractory Osteomyelitis	UHMS	UHMS-approved (adjunct) · SAUHMA Level C · no RCTs	1
Delayed Radiation Injury (ORN & Soft Tissue)	UHMS	UHMS-approved · SAUHMA Level B · positive RCTs (proctitis, cystitis) & one null (HOPON)	9
Thermal Burns	UHMS	UHMS-approved (adjunct) — GUARDED/CONTESTED · Cochrane: insufficient evidence	2
Idiopathic Sudden Sensorineural Hearing Loss	UHMS	UHMS-approved (adjunct to steroids, early) · SAUHMA Level B	2
Avascular Necrosis (Femoral Head)	UHMS	UHMS-approved (15th ed ch15) · SAUHMA Level 1 · Camporesi RCT positive · benefit is stage-dependent (best pre-collapse)	4
Investigational — Neurological (TBI & Stroke)	INVEST.	INVESTIGATIONAL — NOT a UHMS-approved indication · emerging evidence only	5
Overview, Mechanisms & Society Guidance	GENERAL	Cross-cutting — mechanisms, indication lists & consensus statements	4

Air or Gas Embolism 2014

Hyperbaric oxygen treatment for air or gas embolism.

Moon RE · Undersea Hyperb Med

Lvl 5Review

Evidence-based review of HBOT for arterial and venous gas embolism. Arterial gas embolism (AGE) — from alveolar-capillary disruption, decompression, surgery or iatrogenic injection — produces stroke-like deficits; small venous gas emboli are often tolerated but can cause pulmonary edema, cardiac vapor-lock and paradoxical AGE. Intravascular gas is frequently invisible on imaging, which must not exclude the diagnosis. Treatment mirrors decompression sickness: first-aid oxygen then hyperbaric oxygen; adjunctive therapies are reviewed.

PubMed · PMID 24851554 ↗

Decompression Sickness 2012

Recompression and adjunctive therapy for decompression illness (Cochrane Review).

Bennett MH, Lehm JP, Mitchell SJ, Wasiak J · Cochrane Database Syst Rev

Lvl 1a▬ nullSystematic Review

Cochrane review of recompression and adjunctive therapy for decompression illness (DCI), which follows bubble formation after breathing compressed gas. Two RCTs (268 patients). Adding an NSAID (tenoxicam) or using heliox tables may reduce the number of recompressions required but neither improves odds of recovery. Recompression remains the accepted standard despite no RCT evidence for its core use; large rigorous trials are warranted.

PubMed · PMID 22592704 ↗DOI ↗

Carbon Monoxide Poisoning 2005

Hyperbaric oxygen for carbon monoxide poisoning (Cochrane Review).

Juurlink DN, et al. · Cochrane Database Syst Rev

Lvl 1a▬ nullSystematic Review

Cochrane review of RCTs of HBO versus normobaric oxygen for preventing neurologic sequelae after acute CO poisoning. Six trials; four found no benefit, two did. Pooled analysis did not show benefit (OR 0.78, 95% CI 0.54-1.12) but with significant heterogeneity and design flaws in all trials. Concludes existing trials do not establish whether HBO reduces adverse neurologic outcomes; a multicentre RCT is needed.

PubMed · PMID 15674890 ↗DOI ↗

Carbon Monoxide Poisoning 2011

Hyperbaric oxygen therapy for acute domestic carbon monoxide poisoning: two randomized controlled trials.

Annane D, et al. · Intensive Care Med

Lvl 1b▬ nullRCT

Two parallel RCTs (385 patients, Garches). In patients with transient loss of consciousness, one HBO session showed no superiority over 6 h normobaric oxygen (58% vs 61% complete recovery). In initially comatose patients, two HBO sessions were associated with worse 1-month recovery than one session (47% vs 68%; OR 0.42). A second major counterweight to Weaver, arguing against excess HBO dosing in coma.

PubMed · PMID 21125215 ↗DOI ↗

Carbon Monoxide Poisoning 2002

Hyperbaric oxygen for acute carbon monoxide poisoning.

Weaver LK, et al. · N Engl J Med

Lvl 1b▲ positiveRCT

Pivotal double-blind RCT (Weaver, NEJM): 152 patients with symptomatic acute CO poisoning randomized to three hyperbaric-oxygen sessions vs one normobaric-oxygen session plus sham. Cognitive sequelae at 6 weeks were less frequent with HBO (25.0% vs 46.1%, P=0.007; adjusted OR 0.45), with benefit sustained at 12 months (P=0.04). The Level-A anchor trial supporting HBOT for CO poisoning.

PubMed · PMID 12362006 ↗DOI ↗

Carbon Monoxide Poisoning 1999

Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial.

Scheinkestel CD, et al. · Med J Aust

Lvl 1b▬ nullRCT

Double-blind sham-controlled RCT (Melbourne) of HBO vs normobaric oxygen for all grades of CO poisoning, with both arms receiving high-flow oxygen between treatments. HBO did not benefit and may have worsened outcome: more HBO patients required additional treatments and had worse learning-test results; delayed neurological sequelae were restricted to HBO patients. A key counterweight trial; the high-dose NBO control arm is the main design critique.

PubMed · PMID 10092916 ↗DOI ↗

Carbon Monoxide Poisoning 2010

Carbon monoxide poisoning (acute).

Smollin C, Olson K · BMJ Clin Evid

Lvl 2aSystematic Review

Systematic review (BMJ Clinical Evidence) addressing the effects of oxygen treatments for acute CO poisoning, with GRADE evaluation of 12 systematic reviews/RCTs/observational studies. Compares 100% hyperbaric oxygen, 28% oxygen and 100% oxygen by non-rebreather mask, presenting effectiveness and safety data to guide acute management.

PubMed · PMID 21418677 ↗

Gas Gangrene (Clostridial Myonecrosis) 2015

Interventions for treating gas gangrene (Cochrane Review).

Yang Z, et al. · Cochrane Database Syst Rev

Lvl 1a▬ nullSystematic ReviewMeta-analysis

Cochrane review of interventions for gas gangrene, a rapidly progressive infection with high amputation risk. Only two small RCTs (90 participants) met criteria; one compared topical vs systemic HBOT (no difference: RR 1.10, 95% CI 0.25-4.84). Evidence was very low quality. Standard care combines urgent debridement, antibiotics and HBOT, but robust RCTs are lacking to determine which interventions are safe and effective.

PubMed · PMID 26631369 ↗DOI ↗

Necrotizing Soft Tissue Infections 2023

The effect of hyperbaric oxygen therapy on the clinical outcomes of necrotizing soft tissue infections: a systematic review and meta-analysis.

Huang C, et al. · World J Emerg Surg

Lvl 2a▲ positiveMeta-analysisSystematic Review

Meta-analysis of observational studies (49,152 patients; 1448 HBOT). Mortality was significantly lower in the HBOT group (RR 0.52, 95% CI 0.40-0.68) and multiple-organ-dysfunction incidence lower (RR 0.21). HBOT patients underwent more debridements; no significant difference in amputation rates. Evidence is weak (retrospective) but suggests HBOT reduces mortality and complications in NSTI; prompt surgery remains essential and HBOT is not universally available.

PubMed · PMID 36966323 ↗DOI ↗

Crush Injury & Acute Traumatic Ischemia 1996

Hyperbaric oxygen therapy in the management of crush injuries: a randomized double-blind placebo-controlled clinical trial.

Bouachour G, et al. · J Trauma

Lvl 1b▲ positiveRCT

Double-blind placebo-controlled RCT (36 patients) of adjunctive HBO (2.5 ATA, 90 min BID x6 days) after surgery for limb crush injuries. Complete healing in 17/18 (HBO) vs 10/18 (placebo, P<0.01); new surgical procedures (flaps, grafts, vascular surgery, amputation) in 1 vs 6 (P<0.05). Benefit greatest in patients >40 with grade III soft-tissue injury. The Level-B anchor trial for acute traumatic ischaemia.

PubMed · PMID 8760546 ↗DOI ↗

Central Retinal Artery Occlusion 2017

Hyperbaric oxygen in the treatment of acute retinal artery occlusion.

Elder MJ, Rawstron JA, Davis M · Diving Hyperb Med

Lvl 4▲ positiveObservational

Retrospective series of 31 consecutive acute retinal artery occlusion patients referred for HBOT (Christchurch). 23 had temporary visual improvement with the first treatment; 7 achieved permanent good recovery (6/18 or better) and 2 modest improvement — all 9 permanent responders were treated within 10 hours of symptom onset. Supports HBOT for ARAO (recommended by UHMS and ECHM) while noting the authors' protocol may have been insufficiently aggressive; an RCT is feasible but logistically/ethically difficult.

PubMed · PMID 29241233 ↗DOI ↗

Central Retinal Artery Occlusion 2021

Hyperbaric Oxygen Therapy for Central Retinal Artery Occlusion: Patient Selection and Perspectives.

Celebi ARC · Clin Ophthalmol

Lvl 5Review

Narrative review of HBOT for central retinal artery occlusion (CRAO), an ophthalmological emergency. HBOT is classified by the American Heart Association at level IIb for CRAO and can maintain retinal oxygenation via choroidal diffusion during ischaemia. Time to initiation is the most critical prognostic factor; UHMS recommends evaluation within 24 hours of symptom onset. HBOT has a low risk profile and may improve visual outcomes in appropriately selected patients.

PubMed · PMID 34413628 ↗DOI ↗

Severe Anemia 2012

The effect of hyperbaric oxygen on severe anemia.

Van Meter KW · Undersea Hyperb Med

Lvl 5Review

Review of HBOT as bridge therapy for severe anaemia when transfusion is unavailable or refused. Hyperbaric oxygen dissolves sufficient oxygen in plasma to supply tissues independent of haemoglobin, reducing oxygen debt in exsanguination through to the severely anaemic patient who cannot be transfused (religious, immunologic or availability reasons); intermittent oxygen may also stimulate red-cell/haemoglobin mass. Positions HBOT as a low-technology, cost-competitive adjunct (a treatment costing about one unit of packed cells).

PubMed · PMID 23045922 ↗

Intracranial Abscess 2021

Hyperbaric oxygen for intracranial abscess.

Tomoye EO, Moon RE · Undersea Hyperb Med

Lvl 5Review

UHMS review of adjunctive HBO for intracranial abscess (cerebral abscess, subdural and epidural empyema), which share etiologies (contiguous sinus/otogenic/dental infection, haematogenous seeding, cranial trauma). Given the high morbidity and mortality of intracranial abscess and HBO's relatively non-invasive nature and low complication rate, the risk-benefit ratio favours adjunctive HBO in selected patients alongside neurosurgery and antibiotics.

PubMed · PMID 33648039 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2024

Effects of different treatment measures on the efficacy of diabetic foot ulcers: a network meta-analysis.

OuYang H, et al. · Front Endocrinol (Lausanne)

Lvl 1a▲ positiveNetwork MA

Network meta-analysis of 57 RCTs (4826 DFU patients) comparing treatments. Versus standard of care, PRP, HBOT, topical oxygen therapy, acellular dermal matrix and stem cells all significantly increased complete healing rate. Combination therapies (e.g., PRP+NPWT, UD+NPWT) outperformed single modalities for healing, area reduction, healing time and amputation rates.

PubMed · PMID 39377075 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2021

Efficacy of hyperbaric oxygen therapy for diabetic foot ulcers: An updated systematic review and meta-analysis.

Zhang Z, et al. · Asian J Surg

Lvl 1a▲ positiveMeta-analysisSystematic Review

Systematic review and meta-analysis of 20 RCTs (1263 patients). HBOT increased the healing rate of diabetic foot ulcers (RR 1.90, 95% CI 1.48-2.44), shortened healing time (MD -19.36 days), and reduced the incidence of major amputation (RR 0.52, 95% CI 0.32-0.83). Concludes HBOT offers benefits for DFU healing and amputation reduction; larger well-designed RCTs still needed.

PubMed · PMID 34376365 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2021

The role of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers: a systematic review with meta-analysis of randomized controlled trials on limb amputation and ulcer healing.

Moreira da Cruz DL, Oliveira-Pinto J, Mansilha A · Int Angiol

Lvl 1a▲ positiveMeta-analysisSystematic Review

Systematic review/meta-analysis of 11 RCTs (668 patients) from a vascular surgery group (Porto). Adjuvant HBOT lowered risk of major amputation (OR 0.53, 95% CI 0.32-0.90), increased ulcer healing (OR 4.00, 95% CI 1.54-10.44), and gave greater ulcer-area reduction at two weeks (mean difference 23.19%). No difference in minor amputations. Benefit in selected patients; larger studies needed.

PubMed · PMID 34236155 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2021

Efficacy of hyperbaric oxygen therapy for diabetic foot ulcer, a systematic review and meta-analysis of controlled clinical trials.

Sharma R, et al. · Sci Rep

Lvl 1a▲ positiveMeta-analysisSystematic Review

Fourteen studies (768 participants; 12 RCTs, 2 CCTs). Pooled analysis: HBOT significantly effective for complete healing of DFU (OR 0.29, 95% CI 0.14-0.61) and reduction of major amputation (RR 0.60, 95% CI 0.39-0.92); not effective for minor amputations; no difference in mean ulcer-area reduction or mortality. Evidence supports HBOT as an adjunct for DFU, generalized cautiously given methodological flaws.

PubMed · PMID 33500533 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2020

A systematic review and meta-analysis of hyperbaric oxygen therapy for diabetic foot ulcers with arterial insufficiency.

Brouwer RJ, et al. · J Vasc Surg

Lvl 1a▲ positiveMeta-analysisSystematic Review

Systematic review of HBOT as adjunct for DFU with peripheral arterial occlusive disease (PAOD). Eleven studies (729 patients; 7 RCTs). Meta-analysis showed significantly fewer major amputations in the HBOT group (10.7% vs 26.0%; risk difference -15%; NNT 7), no difference for minor amputations, contrasting wound-healing results, and no difference in mortality or amputation-free survival. Better patient selection may define who with DFU+PAOD benefits most.

PubMed · PMID 32040434 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2015

Hyperbaric oxygen therapy for chronic wounds (Cochrane Review).

Kranke P, Bennett MH, et al. · Cochrane Database Syst Rev

Lvl 1a▲ positiveSystematic ReviewMeta-analysis

Cochrane review of adjunctive HBOT for chronic lower-limb ulcers; 12 RCTs (577 participants). In diabetic foot ulcers, pooled data showed increased healing at 6 weeks (RR 2.35, 95% CI 1.19-4.62) but no benefit at 1 year, and no significant difference in major amputation (RR 0.36, 95% CI 0.11-1.18). Trials had design/reporting flaws limiting confidence. The standard Cochrane evidence anchor for HBOT in chronic wounds.

PubMed · PMID 26106870 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2016

Hyperbaric Oxygen Therapy Does Not Reduce Indications for Amputation in Patients With Diabetes With Nonhealing Ulcers of the Lower Limb: A Prospective, Double-Blind, Randomized Controlled Clinical Trial.

Fedorko L, et al. · Diabetes Care

Lvl 1b▬ nullRCT

Double-blind RCT (103 analysed) of 30 sessions HBOT vs sham air added to comprehensive wound care in chronic diabetic foot ulcers (Wagner 2-4). Criteria for major amputation met in 13/54 (sham) vs 11/49 (HBOT) (OR 0.91, P=0.85); healing 22% vs 20% (P=0.82); no wound-healing index differed. The principal RCT-level negative signal, important for balanced appraisal of HBOT in DFU.

PubMed · PMID 26740639 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2010

Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes (HODFU).

Löndahl M, et al. · Diabetes Care

Lvl 1b▲ positiveRCT

HODFU: randomized, single-centre, double-blind, placebo-controlled trial (94 patients, Wagner 2-4 ulcers >3 months) comparing HBOT with hyperbaric air, 40 sessions. Complete healing of the index ulcer at 1 year was 52% (HBOT) vs 29% (placebo, P=0.03); 61% vs 27% among those completing >35 sessions (P=0.009). The air-sham comparator is a methodological strength. Positive RCT anchor for HBOT in chronic diabetic foot ulcers.

PubMed · PMID 20427683 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2023

Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update).

Chen P, et al. (IWGDF) · Diabetes Metab Res Rev

GuidelineSystematic ReviewGuideline

2023 IWGDF evidence-based guideline on wound-healing interventions for diabetes-related foot ulcers, using GRADE. Of 29 recommendations, conditional supportive recommendations include sucrose octasulfate dressings, NPWT for post-operative wounds, placental-derived products, autologous leucocyte/platelet/fibrin patch, topical oxygen therapy, and hyperbaric oxygen — to be used where best standard of care alone cannot heal the wound and resources allow.

PubMed · PMID 37232034 ↗DOI ↗

Problem Wounds (Diabetic Foot & Arterial Insufficiency) 2003

Hyperbaric oxygen for treating wounds: a systematic review of the literature.

Wang C, et al. · Arch Surg

Lvl 2aSystematic Review

Systematic review of 57 studies (7 RCTs, >2000 patients) on HBO as adjunct for hypoxic wounds. Results suggest HBO may benefit chronic nonhealing diabetic wounds, compromised skin grafts, osteoradionecrosis, soft tissue radionecrosis and gas gangrene versus standard care alone. Serious adverse events include seizures and pressure-related trauma. Overall study quality poor; high-quality RCTs needed to define timing and patient-selection criteria.

PubMed · PMID 12611573 ↗DOI ↗

Compromised Grafts & Flaps 2017

Hyperbaric Oxygen Therapy for the Compromised Graft or Flap.

Francis A, Baynosa RC · Adv Wound Care (New Rochelle)

Lvl 5Review

Review of HBO for salvage of compromised grafts and flaps. HBO can increase the likelihood and effective size of composite graft survival, improve skin-graft outcomes and enhance flap survival, via increased oxygenation, improved fibroblast function, neovascularization and amelioration of ischaemia-reperfusion injury. Animal studies show clear benefit; clinical support is limited to case reports/series, and multicentre prospective and cost-analysis studies are still needed.

PubMed · PMID 28116225 ↗DOI ↗

Refractory Osteomyelitis 2021

Hyperbaric oxygen for refractory osteomyelitis.

Hart BB · Undersea Hyperb Med

Lvl 5Review

UHMS review of HBO for refractory (chronic, persistent/recurrent) osteomyelitis. No RCTs exist, but the literature indicates that adding HBO to surgical debridement and culture-directed antibiotics is safe and improves infection-resolution rates, with best results when HBO starts soon after debridement. Where extensive debridement or hardware removal is relatively contraindicated (cranial, spinal, sternal, paediatric), a trial of antibiotics plus HBO is reasonable. Typical regimen: 2.0-3.0 ATA, 90-120 min daily, 20-40 sessions.

PubMed · PMID 34390634 ↗

Delayed Radiation Injury (ORN & Soft Tissue) 2023

Hyperbaric oxygen therapy for late radiation tissue injury (Cochrane Review, 2023 update).

Lin ZC, Bennett MH, et al. · Cochrane Database Syst Rev

Lvl 1a▲ positiveSystematic ReviewMeta-analysis

Third update of the landmark Cochrane review; 18 RCTs (1071 participants, 1985-2022). HBOT may produce complete resolution/significant improvement of late radiation tissue injury (RR 1.39, 95% CI 1.02-1.89) and a large reduction in wound dehiscence after head-and-neck surgery (RR 0.24). Pain in osteoradionecrosis improved modestly at 12 months. HBOT unlikely to affect short-term death; adverse events include reduced visual acuity (usually temporary) and ear barotrauma. Application to selected patients may be justified. The key evidence base for HBOT in radiation injury.

PubMed · PMID 37585677 ↗DOI ↗

Delayed Radiation Injury (ORN & Soft Tissue) 2019

Radiation-induced cystitis treated with hyperbaric oxygen therapy (RICH-ART): a randomised, controlled, phase 2-3 trial.

Oscarsson N, et al. · Lancet Oncol

Lvl 1b▲ positiveRCT

Multicentre Nordic phase 2-3 RCT (RICH-ART; 79 analysed) of HBOT (30-40 sessions) vs standard care for late radiation cystitis. Change in EPIC urinary total score favoured HBOT by 10.1 points (95% CI 2.2-18.1; p=0.013). Transient grade 1-2 adverse events (sight/hearing) in 41%. Concludes HBOT is a safe, well-tolerated treatment that relieves late radiation-cystitis symptoms.

PubMed · PMID 31537473 ↗DOI ↗

Delayed Radiation Injury (ORN & Soft Tissue) 2019

HOPON: A Randomized Controlled Trial of Hyperbaric Oxygen to Prevent Osteoradionecrosis of the Irradiated Mandible After Dentoalveolar Surgery.

Shaw RJ, et al. · Int J Radiat Oncol Biol Phys

Lvl 1b▬ nullRCT

Phase 3 RCT (100 analysed) testing HBO (30 dives, 2.4 ATA) to prevent osteoradionecrosis after dental extraction/implant in the irradiated mandible; all received chlorhexidine and antibiotics. ORN incidence at 6 months was 6.4% (HBO) vs 5.7% (control) (OR 1.13, P=1.0), with fewer acute symptoms but no late benefit. The low ORN rate led authors to conclude routine HBO is unnecessary — challenging the Marx-era standard.

PubMed · PMID 30851351 ↗DOI ↗

Delayed Radiation Injury (ORN & Soft Tissue) 2008

Hyperbaric oxygen treatment of chronic refractory radiation proctitis: a randomized and controlled double-blind crossover trial with long-term follow-up.

Clarke RE, et al. · Int J Radiat Oncol Biol Phys

Lvl 1b▲ positiveRCT

Double-blind crossover RCT (120 evaluable) of HBO (2.0 ATA) vs sham air for refractory radiation proctitis. HBO significantly improved healing (SOMA-LENT) responses, with 88.9% vs 62.5% responders and an absolute risk reduction of 32% (number needed to treat 3) after initial allocation, plus better bowel-specific quality of life. A positive RCT anchor for HBOT in radiation-induced pelvic soft-tissue injury.

PubMed · PMID 18342453 ↗DOI ↗

Delayed Radiation Injury (ORN & Soft Tissue) 1985

Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin.

Marx RE, Johnson RP, Kline SN · J Am Dent Assoc

Lvl 1b▲ positiveRCT

Classic Marx RCT: in high-risk patients needing tooth removal in irradiated mandibles, prophylactic HBOT produced an osteoradionecrosis incidence of 5.4% versus 29.9% with penicillin (P=0.005). Established HBO as a prophylactic measure before post-irradiation dental trauma and underpins the widely used Marx staging/protocol — though later challenged by the HOPON trial.

PubMed · PMID 3897335 ↗DOI ↗

Delayed Radiation Injury (ORN & Soft Tissue) 2014

MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy.

Lalla RV, et al. (MASCC/ISOO) · Cancer

GuidelineGuidelineSystematic Review

Updated MASCC/ISOO clinical practice guidelines for mucositis from cancer therapy. Systematic review of 570 included papers producing 32 guidelines (22 oral, 10 gastrointestinal mucositis). Provides evidence-based recommendations across interventions in specific treatment settings, including the role of hyperbaric oxygen among supportive-care measures for radiation-related mucosal injury.

PubMed · PMID 24615748 ↗DOI ↗

Delayed Radiation Injury (ORN & Soft Tissue) 2021

Osteoradionecrosis: Exposing the Evidence Not the Bone.

Frankart AJ, et al. · Int J Radiat Oncol Biol Phys

Lvl 2aSystematic Review

Comprehensive review (focused on the prior decade) of the diagnosis and management of osteoradionecrosis (ORN), a rare but morbid and costly complication of head-and-neck radiotherapy. Emphasizes multidisciplinary diagnosis and treatment and addresses the role of adjuncts including hyperbaric oxygen amid a lack of broad consensus on overall management.

PubMed · PMID 33412258 ↗DOI ↗

Delayed Radiation Injury (ORN & Soft Tissue) 2018

Scoping Review and Meta-analysis of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis.

Cardinal J, et al. · Curr Urol Rep

Lvl 2a▲ positiveMeta-analysisSystematic Review

Scoping review/meta-analysis of HBOT for radiation-induced urologic injury (13 studies). Of 602 patients treated with HBOT for hemorrhagic radiation cystitis, 84% had partial or complete resolution; 75% improved hematuria by at least one RTOG/EORTC grade. Of 499 with follow-up, 14% recurred (median 10 months). Confirms safety and efficacy though only one RCT existed (2012).

PubMed · PMID 29654564 ↗DOI ↗

Delayed Radiation Injury (ORN & Soft Tissue) 2016

Hyperbaric oxygen therapy and osteonecrosis.

Ceponis P, Keilman C, Guerry C, Freiberger JJ · Oral Dis

Lvl 5Review

Review (Duke) of adjunctive HBO for osteonecrosis of the jaw arising from radiation, medication (MRONJ) or infection. Optimal therapy is multimodal, combining surgery with adjuncts. Summarises the basic and clinical science of HBO for these conditions and discusses field controversies and economic implications — useful context alongside the Marx and HOPON osteoradionecrosis trials.

PubMed · PMID 27062390 ↗DOI ↗

Thermal Burns 2004

Hyperbaric oxygen therapy for thermal burns (Cochrane Review).

Villanueva E, Bennett MH, Wasiak J, Lehm JP · Cochrane Database Syst Rev

Lvl 1a▬ nullSystematic Review

Cochrane review of HBOT for thermal burns. Only two RCTs met inclusion criteria, both of poor methodological quality, precluding data pooling. One reported no difference in length of stay, mortality or surgeries after adjustment; the other reported shorter mean healing time with HBOT (19.7 vs 43.8 days). Concludes there is insufficient evidence to support or refute HBOT for thermal burns — the basis for the 'guarded/contested' status of this indication.

PubMed · PMID 15266540 ↗DOI ↗

Thermal Burns 2021

Hyperbaric oxygen for thermal burns.

Cianci P, Sato RM, Faulkner J · Undersea Hyperb Med

Lvl 5Review

UHMS-oriented review arguing that a consistent body of animal and human evidence supports HBOT in thermal injury: preventing dermal ischaemia, reducing edema, modulating the zone of stasis, limiting partial-to-full-thickness conversion, preserving cellular metabolism and promoting healing. Clinical reports describe reductions in mortality, length of stay, number of surgeries and cost. Emphasises safety with trained delivery and mandatory careful patient selection. Presents the pro-HBOT case that contrasts with the Cochrane appraisal.

PubMed · PMID 34847309 ↗

Idiopathic Sudden Sensorineural Hearing Loss 2024

Salvage therapy for refractory sudden sensorineural hearing loss (RSSNHL): a systematic review and network meta-analysis.

Lin CY, et al. · Int J Audiol

Lvl 1a▲ positiveNetwork MASystematic Review

Network meta-analysis comparing five salvage regimens for refractory SSNHL: intratympanic steroids (ITS), HBO, post-auricle steroid injection (PSI), ITS+HBO, and continued systemic steroids. PSI and ITS gave the greatest hearing gains overall; under a restricted RSSNHL definition, ITS+HBO showed the largest pure-tone-average improvement vs control (14.5 dB, 95% CI 4.2-25.0). A consensus definition of RSSNHL is needed.

PubMed · PMID 38251843 ↗DOI ↗

Idiopathic Sudden Sensorineural Hearing Loss 2022

Hyperbaric Oxygen Therapy for Patients With Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis.

Joshua TG, Ayub A, Wijesinghe P, Nunez DA · JAMA Otolaryngol Head Neck Surg

Lvl 1a▲ positiveMeta-analysisSystematic Review

Meta-analysis of 3 prospective RCTs (150 adults) of HBOT for sudden sensorineural hearing loss. HBOT as part of combination treatment was significantly associated with improved hearing: mean absolute hearing gain difference 10.3 dB (95% CI 6.5-14.1) and odds ratio of hearing recovery 4.3 (95% CI 1.6-11.7), favouring HBOT over control. Supports HBOT as an adjunct despite it not being widely offered.

PubMed · PMID 34709348 ↗DOI ↗

Avascular Necrosis (Femoral Head) 2010

Hyperbaric oxygen therapy in femoral head necrosis.

Camporesi EM, et al. · J Arthroplasty

Lvl 1b▲ positiveRCT

Double-blind, randomized, controlled trial (Camporesi): 20 patients with unilateral Ficat stage II femoral head necrosis received 30 treatments of hyperbaric oxygen or compressed air (sham) over 6 weeks. HBO produced significant pain improvement after 20 treatments and significant range-of-motion gains between 20 and 30 treatments. After unblinding, sham patients crossed to HBO; at 7 years all patients remained substantially pain-free, none required hip arthroplasty, and 7 of 9 hips showed substantial radiographic healing. The randomised anchor supporting HBOT in early (pre-collapse) femoral head necrosis.

PubMed · PMID 20637561 ↗DOI ↗

Avascular Necrosis (Femoral Head) 2017

Clinical effect of hyperbaric oxygen therapy in the treatment of femoral head necrosis: A systematic review and meta-analysis.

Li W, et al. · Orthopade

Lvl 2a▲ positiveMeta-analysisSystematic Review

Meta-analysis of 9 studies (623 patients) of HBO for femoral head necrosis. Clinical effect was markedly higher with HBO than control (OR 4.95, 95% CI 3.24-7.55, P<0.00001), consistent across Asian and non-Asian subgroups. Concludes HBO significantly improves clinical outcomes in femoral head necrosis and is worthy of clinical application, though the included studies are largely non-randomised.

PubMed · PMID 27928615 ↗DOI ↗

Avascular Necrosis (Femoral Head) 2016

Hyperbaric oxygen therapy in the treatment of osteonecrosis of the femoral head: a review of the current literature.

Uzun G, Mutluoglu M, Ersen O, Yildiz S · Undersea Hyperb Med

Lvl 2aSystematic Review

Systematic literature review of HBO therapy for osteonecrosis of the femoral head; 8 clinical studies (2 RCTs, one historically controlled study, 5 case series), mostly small-scale and methodologically weak, with four combining HBO with other modalities. Where HBO was used alone, hip survivorship was 95.5% (Steinberg I), 89% (Steinberg II) and 100% (Ficat II). Concludes there is a role for HBO in ONFH management but further RCTs are required to define it.

PubMed · PMID 27416686 ↗

Avascular Necrosis (Femoral Head) 2015

Hyperbaric oxygen for stage I and II femoral head osteonecrosis.

Koren L, et al. · Orthopedics

Lvl 4▲ positiveObservational

Cohort of 68 patients (78 joints) with symptomatic Steinberg stage I-II femoral head osteonecrosis treated with HBOT. 88% of joints improved on post-treatment MRI; at mean 11-year follow-up, 93% of joints survived. Harris Hip Score improved from 21 to 81 and the SF-12 physical component from 24 to 46 (both P<0.0001). Concludes HBOT is effective at preserving the hip in early-stage femoral head osteonecrosis.

PubMed · PMID 25760507 ↗DOI ↗

Investigational — Neurological (TBI & Stroke) 2025

A double-blind randomized trial of hyperbaric oxygen for persistent symptoms after brain injury.

Weaver LK, et al. · Sci Rep

Lvl 1b▲ positiveRCT

Double-blind RCT: adults with persistent symptoms after non-stroke brain injury received 40 HBO or 40 sham sessions over 12 weeks. Mean 13-week change in Neurobehavioral Symptom Inventory favoured HBO (mean difference 7.0, 95% CI 1.7-12.3, p=0.01), with improvements in olfaction, anxiety, sleep and vestibular complaints. Both groups improved on depression, headaches and PTSD symptoms. A recent rigorously blinded trial in post-brain-injury symptoms.

PubMed · PMID 40011516 ↗DOI ↗

Investigational — Neurological (TBI & Stroke) 2024

Hyperbaric Oxygen Therapy (HBOT) in Moderate Traumatic Brain Injury (TBI): A Randomized Controlled Trial.

Chaturvedi J, et al. · Asian J Neurosurg

Lvl 1b▲ positiveRCT

RCT in moderate TBI: standard care plus 10 daily adjuvant HBOT sessions (60 min at 1.4 ATM) versus standard care alone. Mean Glasgow Coma Score at discharge was higher with HBOT (14.37 vs 13.40, p<0.001) and 3-month Glasgow Outcome Scale-Extended was better (7.62 vs 6.40, p<0.001). Concludes early adjuvant HBOT significantly improves early GCS and 3-month functional outcome versus standard care.

PubMed · PMID 40041595 ↗DOI ↗

Investigational — Neurological (TBI & Stroke) 2022

The management and rehabilitation of post-acute mild traumatic brain injury (VA/DoD guideline synopsis).

Eapen BC, et al. (VA/DoD) · Brain Inj

GuidelineSystematic ReviewGuideline

Synopsis of the 2021 US VA/DoD joint clinical practice guideline for management and rehabilitation of post-acute mild TBI (persistent post-concussion symptoms). A multidisciplinary team used GRADE to produce 19 recommendations and two care algorithms, addressing symptom-based treatment and adjuncts including hyperbaric oxygen therapy for the primary-care management of mTBI.

PubMed · PMID 35152817 ↗DOI ↗

Investigational — Neurological (TBI & Stroke) 2022

Systematic Review and Dosage Analysis: Hyperbaric Oxygen Therapy Efficacy in Mild Traumatic Brain Injury Persistent Postconcussion Syndrome.

Harch PG · Front Neurol

Lvl 2a▲ positiveSystematic Review

Systematic review with dose analysis treating HBOT as a dual-component drug (pressure + hyperoxia) in persistent post-concussion syndrome after mild TBI. Eleven studies (6 RCTs). HBOT at 1.5 ATA (40 sessions) produced statistically significant symptomatic and cognitive improvements across four randomized trials; benefit was greater with comorbid PTSD. Increased pressure within a narrow range appears more important than oxygen dose. Authors argue the 1.5 ATA data meet CEBM Level 1 criteria.

PubMed · PMID 35370898 ↗DOI ↗

Investigational — Neurological (TBI & Stroke) 2020

Hyperbaric oxygen therapy improves neurocognitive functions of post-stroke patients - a retrospective analysis.

Hadanny A, et al. · Restor Neurol Neurosci

Lvl 4▲ positiveObservational

Retrospective analysis of 162 chronic post-stroke patients (>3 months) treated with 40-60 HBOT sessions at 2 ATA. HBOT produced significant improvement across all cognitive domains, with 86% achieving clinically significant improvement, independent of stroke type, location or side. Baseline cognitive score, not stroke characteristics, predicted response. Suggests patient selection should be based on functional/cognitive baseline rather than lesion features.

PubMed · PMID 31985478 ↗DOI ↗

Overview, Mechanisms & Society Guidance 2017

Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment.

Mathieu D, Marroni A, Kot J · Diving Hyperb Med

GuidelineGuidelineSystematic Review

ECHM tenth European Consensus Conference (2016) revised the list of accepted HBOT indications using modified GRADE and DELPHI consensus. Indications classified Type 1 (strongly indicated, strong evidence), Type 2 (suggested), Type 3 (optional), each with evidence levels A/B/C. For the first time issued 'negative' recommendations where Type 1 evidence indicates HBOT is NOT indicated, plus consensus standards of practice. A key European reference list of indications.

PubMed · PMID 28357821 ↗DOI ↗

Overview, Mechanisms & Society Guidance 2021

A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities.

Ortega MA, et al. · Medicina (Kaunas)

Lvl 5Review

HBOT uses pure oxygen at increased pressure (2-3 ATA) leading to hyperoxemia and hyperoxia, with antimicrobial, immunomodulatory and angiogenic properties. Reviews the physiological relevance of oxygen and the therapeutic basis of HBOT, current indications and underlying mechanisms, plus potential research areas including inflammatory/systemic disease, COVID-19 and cancer, and adverse effects and contraindications.

PubMed · PMID 34577787 ↗DOI ↗

Overview, Mechanisms & Society Guidance 2018

Hyperbaric oxygen therapy: Antimicrobial mechanisms and clinical application for infections.

Memar MY, et al. · Biomed Pharmacother

Lvl 5Review

Reviews the antimicrobial mechanisms of HBOT and its application in infection. Antimicrobial effects arise partly from reactive oxygen species, enhancement of immune-cell antimicrobial activity, and additive/synergistic effects with antibiotics. Described as useful in deep/chronic infections such as necrotizing fasciitis, osteomyelitis, chronic soft tissue infections and infective endocarditis.

PubMed · PMID 30399579 ↗DOI ↗

Overview, Mechanisms & Society Guidance 2016

ENT indications for Hyperbaric Oxygen Therapy.

Germonpre P, et al. · B-ENT

Lvl 5Review

Reviews ENT indications for HBOT. Beneficial adjunctive effects are summarized as anti-ischaemic (oxygen delivery to ischaemic tissue, reduced ischaemia-reperfusion damage), anti-infectious (bacteriostasis, improved leucocyte activity, antibiotic optimization) and wound-healing (granulation tissue formation). Argues HBOT should be an integral part of combined surgical/pharmacological treatment for selected patients.

PubMed · PMID 29461736 ↗

No articles match your filters.