Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy is based on breathing 100% oxygen under higher-than-normal atmospheric pressure in a dedicated pressure chamber. It can be beneficial in some medical conditions; however, it is not a standard solution for every wound, every infection, or every chronic problem, and the indication must be established correctly. ^[1][2][3]

What is hyperbaric oxygen therapy?

Hyperbaric oxygen therapy is abbreviated as HBOT. During treatment, the person breathes 100% oxygen inside a pressurized chamber at a pressure above normal atmospheric pressure. This environment aims to increase the amount of dissolved oxygen carried from the lungs into the blood and tissues. The basic idea is to deliver more oxygen to tissues with impaired oxygenation or impaired healing. ^[1][2][3]

This method is sometimes referred to as pressure chamber treatment. Even so, the fact that the term sounds impressive does not mean the treatment is supported by evidence in every setting. Hyperbaric therapy is used in specific approved or accepted indications, and in some conditions it functions as an adjunct rather than the main treatment. For that reason, the idea that “oxygen is good, so it must help everyone” is not medically accurate. ^[1][2][4]

How does it work?

The combination of higher pressure and pure oxygen can support tissues that are otherwise difficult to oxygenate by increasing the amount of oxygen dissolved in plasma. In some wounds this may contribute to healing; in certain infections it may provide supportive benefit; and in problems related to gas bubbles it may offer a physiological advantage. In decompression sickness and air or gas embolism, for example, the mechanism is not simply oxygen delivery—the pressure change itself is part of the treatment. ^[1][2][3]

Even so, the benefit of hyperbaric oxygen therapy varies according to the disease being treated. An approach that is strongly recommended for one indication may be experimental or controversial in another. That is why it is important not only to understand the mechanism, but also to understand in which clinical settings and for what reason the treatment is used. ^[1][2][4]

In which situations may it be used?

Accepted uses of hyperbaric oxygen therapy include decompression sickness, air or gas embolism, some cases of carbon monoxide poisoning, late radiation injury, certain non-healing wounds, selected soft-tissue infections, refractory osteomyelitis, and some graft or flap problems. Even so, the decision in each patient depends on the type and severity of the problem and on accompanying treatments. ^[1][2][5]

For example, in diabetic foot ulcers, hyperbaric therapy is not sufficient on its own. Independent of chamber treatment, wound care, infection control, vascular assessment, and blood glucose management remain essential. Likewise, in radiation injury, hyperbaric treatment is usually considered together with other therapies and through joint decision-making among the relevant specialists. ^[1][2][4]

How is the treatment given?

Treatment may be delivered in single-person or multi-person hyperbaric chambers. Session length, pressure level, and the total number of sessions vary according to the condition being treated. In some patients one or a few sessions are enough, whereas in chronic wounds longer protocols may be necessary. Oxygen may be delivered through a mask, a hood, or another system depending on the chamber type. ^[1][3][4]

During the session, there may be a feeling of ear pressure or fullness similar to what is experienced during airplane descent. That is why ear pressure-equalizing techniques are taught. The treatment protocol is personalized according to the centre and the indication; choosing a session number arbitrarily is not appropriate. Evaluation by a team experienced in hyperbaric medicine is important. ^[1][2][3]

What are the risks and side effects?

Hyperbaric oxygen therapy is generally provided in a controlled environment, but it is not risk-free. Ear and sinus barotrauma, temporary changes in vision, claustrophobic discomfort, and, rarely, oxygen toxicity may occur. In some lung conditions, risk assessment becomes especially important. This is one reason why a detailed pre-treatment review is necessary. ^[1][2][3]

Some people may see hyperbaric oxygen on the internet as a “side-effect-free miracle method.” That view is misleading. Problems may arise especially when it is used for inappropriate indications, in uncontrolled centres, or without following safety rules. Hyperbaric therapy also requires special rules for device safety and fire prevention. ^[1][2][4]

In whom should extra caution be used?

Certain conditions that can cause air trapping in the lungs, some recent surgeries, uncontrolled febrile illnesses, or ear-nose-throat problems that increase the risk of barotrauma may affect treatment planning. In people with claustrophobia, advance assessment and appropriate support are important. A history of seizures and the use of certain medications should also be shared with the clinician. ^[1][2][3]

For that reason, instead of assuming “it helped my neighbour, so it should suit me too,” an individualized risk assessment should be performed. Planning is especially careful in children, older adults, and individuals with multiple medical conditions. Suitability is determined not only by the name of the disease, but also by the patient’s overall condition. ^[1][2][4]

Does hyperbaric oxygen work for every wound?

No. Although improving oxygenation may sound attractive in theory, not every chronic wound benefits from hyperbaric treatment. First, the reason the wound is not healing must be understood: is there a vascular problem, ongoing infection, persistent pressure, or inadequate nutrition? Focusing on hyperbaric therapy alone without addressing the underlying problem is often insufficient. ^[1][2][4]

Similarly, caution is warranted regarding broad claims for sports recovery, anti-ageing applications, or other uses with weak scientific support. In evidence-based medicine, the value of a treatment is judged by whether it shows meaningful benefit in a specific disease group. ^[1][2][3]

When is urgent evaluation needed?

After diving, symptoms such as joint pain, neurological findings, shortness of breath, altered consciousness, or suspected air embolism may make hyperbaric evaluation urgent. Neurological findings after carbon monoxide exposure, serious risk during pregnancy, or severe clinical presentations may also lead to urgent decisions. In such situations, the treatment plan should be coordinated promptly with specialist centres. ^[2][3]

Hyperbaric oxygen therapy can be an important tool in the right indication. Because its benefit varies by disease, however, the decision to use it must be made through specialist evaluation. The safest approach for your personal situation is planning together with a centre experienced in hyperbaric medicine and the relevant primary specialty team. ^[1][2][4]