Hyperbaric oxygen therapy (HBOT) involves breathing over 95% oxygen in a pressurized chamber. In clinics, it is increasingly used as an adjunctive treatment. By increasing oxygen delivery to tissues, HBOT promotes angiogenesis, reduces inflammation, fights certain anaerobic infections, and supports wound healing. These effects reflect measurable changes in the cellular microenvironment, including VEGF and HIF-1 activation, collagen synthesis, stem cell migration, and modulation of inflammatory signaling.
Common Clinical Applications
Diabetic foot ulcers and chronic wounds. HBOT is widely studied for diabetic foot ulcers (DFUs). Systematic reviews and meta-analyses show improved healing rates, greater wound area reduction, and lower major amputation rates when HBOT is added to standard care. It is not a replacement for debridement, offloading, infection control, or vascular assessment.
Compromised skin grafts and flaps. HBOT helps preserve at-risk tissue by reducing hypoxia and attenuating ischemia-reperfusion injury. For compromised grafts, flaps, crush injuries, or exposed fractures, treatment is often started within the first 24–48 hours when clinically safe.
Radiation-induced tissue injury. Late radiation tissue injury can cause necrosis, impaired healing, radiation cystitis, and proctitis. HBOT protocols are longer, often 30–40 sessions at 1.5 ATA or 2.0 ATA, and may improve radiation-induced morbidity and quality of life.
Refractory osteomyelitis and selected infections. Chronic refractory osteomyelitis is difficult to treat because of poor bone vascularity and limited antibiotic penetration. HBOT is a Class II recommendation for chronic refractory osteomyelitis and a Class I intervention for Wagner grade 3 or 4 DFUs with osteomyelitis. One observational study reported 85% infection clearance through HBOT.
Urgent or referral-based care. Clinics may refer or provide urgent care for carbon monoxide poisoning and decompression sickness. These conditions often require hospital resources, including 24-hour availability and critical care support.
Clinic-Based Delivery
Clinic-based HBOT is usually delivered in monoplace chambers for stable outpatients. A typical session lasts 60–120 minutes, with compression and decompression each taking about 10–15 minutes. Patients breathe 100% oxygen via a mask while the chamber is pressurized to 1.5 ATA or 2.0 ATA. Treatment courses vary by indication: DFUs often receive once-daily sessions, while radiation injury may require 30–40 sessions. Most patients receive multiple sessions over weeks, commonly five days per week.
Safety, Protocols, and Equipment
HBOT is generally well tolerated. Common adverse effects include ear and sinus barotrauma, transient visual changes, claustrophobia, and anxiety. Seizure from central nervous system oxygen toxicity occurs in less than 1% of patients. Rare but serious complications include pulmonary barotrauma and pneumothorax; untreated pneumothorax must be excluded before treatment.
Safe clinic-based HBOT depends on rigorous protocols and equipment maintenance. The FDA recommends following manufacturer instructions, continuous patient monitoring, and scheduled cleaning, maintenance, and safety verification. This includes compressor air testing every six months, safety valve replacement every five years, mask hose replacement after each session, and daily pre- and post-use inspections.
Economic and Integration Considerations
In 2026, a single HBOT session cost Medicare $595.86, and limb salvage with HBOT has been found more cost-effective than amputation. One analysis reported a 12-year cost of CAD $40,695 for HBOT versus CAD $49,786 for standard treatment alone in DFU patients. However, cost-effectiveness varies by wound type and patient factors.
HBOT is not a stand-alone cure; it works best within a comprehensive treatment plan. Clinics that integrate HBOT with wound care, surgery, infectious disease, and vascular assessment achieve the best outcomes. For clinics, HBOT can expand specialized wound care services, improve patient outcomes, and reduce hospital referrals. Modern monoplace chambers are designed to support 1.5 ATA and 2.0 ATA protocols safely and practically.
Future Directions
As evidence grows, HBOT will likely play a larger role in outpatient specialty clinics. Emerging applications include surgical preconditioning, post-COVID-19 syndrome, neurological conditions, and inflammatory disorders. Success will depend on standardized protocols, equipment maintenance, and collaboration across specialties.
Šaltiniai
1. Astasio-Picado Á, et al. Comparative Evidence on Negative Pressure Therapy and Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers: A Systematic Review. Medicina. 2026;62(1):109.
2. Geram Health. HBOT Hyperbaric Oxygen Chamber for Traumatic Brain Injury.
3. De Wolde SD, et al. The Effects of Hyperbaric Oxygenation on Oxidative Stress, Inflammation and Angiogenesis. Biomolecules. 2021;11(8):1210.
4. Moon RE. Hyperbare Sauerstofftherapie (HBO). MSD Manual Profi-Ausgabe. Juni 2025.
5. Hyperbaric Treatment of Chronic Refractory Osteomyelitis. StatPearls.
6. Hyperbaric Oxygen Therapy for Late Radiation Tissue Injury. Cochrane Database of Systematic Reviews. 2023;8(8):CD005005.
7. Hyperbaric Geram. Can HBOT Hyperbaric Oxygen Therapy Reverse Age? March 2026.
8. MD Hyperbaric. What Does a Typical Hyperbaric Oxygen Therapy (HBOT) Session Feel Like? November 2025.
