In this article, Wound Care Expert, Christa Bakos discusses the use of Hyperbaric Oxygen Therapy for wound care and other medical conditions. Her discussion includes an explanation of the benefits of HBOT for several conditions as well as the potential side effects and precautions.

The healthcare experts at Robson Forensic are frequently retained to provide expert witness services concerning the quality of care provided by medical professionals.
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What is the Role of Hyperbaric Oxygen Therapy in Medicine?

Hyperbaric Oxygen Therapy (HBOT) is a medical treatment in which a patient breathes 100% oxygen in an enclosed chamber pressurized at greater than one atmosphere of pressure (atm). One atm of pressure equals 14.7 psi which is the amount of earth’s pressure at sea level. Under pressure, oxygen molecules decrease in size enabling them to be easily transported throughout the body thus improving oxygenation. HBOT is most commonly known as a treatment for carbon monoxide poisoning and decompression sickness (the bends) related to SCUBA diving. However, over the past 50 years, HBOT has been used as an adjunct therapy to traditional wound care. Wounds require oxygen to heal and will respond positively to the aggressive oxygenation of HBOT. Currently there are over 100 indications for HBOT recognized by the Undersea and Hyperbaric Medicine Society (UHMS).

How HBOT Works

During HBOT two main actions occur that follow Henry’s Law and Boyle’s Law of Chemistry. Henry’s Law states that under pressure more oxygen can be dissolved into blood plasma, thus allowing a greater concentration of oxygenated blood to circulate through the body. This is known as Hyperoxygenation. Under normal atmospheric pressure, oxygen is transported in the bloodstream by attaching to hemoglobin. Hemoglobin molecules become 96-98% saturated with oxygen during HBOT. Plasma by nature is a poor transporter of oxygen, however under pressure, the decreased size of oxygen molecules enables them to be transported by plasma in the blood stream. Carbon monoxide poisoning and wounds are treated by the HBOT action of Hyperoxygenation which follows Henry’s Law. Boyles Law states that increased pressure will decrease bubble size allowing them to be easily absorbed by the body. Decompression sickness is treated by the HBOT action that follows Boyles Law

In addition to the commonly known uses for HBOT mentioned earlier, additional medical conditions have been recognized as benefiting from this type of treatment. These include:

  • Acute carbon monoxide intoxication
  • Decompression illness
  • Gas embolism
  • Gas gangrene
  • Acute traumatic peripheral ischemia
  • Crush injuries and suturing of severed limbs
  • Progressive necrotizing infections
  • Acute peripheral arterial insufficiency wounds
  • Preparation and preservation of compromised skin grafts
  • Chronic refractory osteomyelitis
  • Osteoradionecrosis
  • Cyanide poisoning
  • Actinomycosis
  • Diabetic lower extremity/foot ulcers

Treatment protocols vary depending on diagnosis and are determined by the physician.

The total amount of frequency and time allotment for HBOT treatments are dependent upon the diagnosis and how the patient responds to the pressure changes. Treatments can be completed in a single or multi-person chamber. Multi-person chambers can accommodate more than one patient as well as patient carts/gurneys. Trained staff will remain in the chamber throughout the treatment. A single chamber can only accommodate one patient at a time.

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HBOT and Wound Care

Research on the effects of HBOT as an adjunct to traditional therapies on wound healing has increased over the last 30 years. In addition to traditional wound care HBOT has been shown to affect all phases of wound healing. With HBOT antibiotic function is increased and there is a direct effect on anaerobic bacteria which is dependent on the absence of oxygen to grow. HBOT decreases the bacterial presence in a wound by increasing the mobility of leukocytes/neutrophils into the wound. The primary function leukocytes/neutrophils are phagocytosis which is the ingestion and removal of bacteria. There has been evidence that HBOT increases collagen synthesis and angiogenesis. Collagen plays an important role in wound healing as it helps increase tissue growth in a wound bed. HBOT increases angiogenesis which is the formation of new blood vessels. Angiogenesisis important for wound healing as these new capillaries enable the formation of granulation tissue which fills in the wound bed. Any lack of oxygen can delay wound healing. HBOT exposes the body to 100% oxygen in a pressurized setting which will decrease the healing times of wounds.

HBOT and Carbon Monoxide Poisoning

HBOT is widely known as a treatment for carbon monoxide poisoning. Carbon monoxide poisoning occurs when there is an over exposure to carbon monoxide. Carbon monoxide binds with hemoglobin to form carboxyhemoglobin. This prevents the red blood cells from carrying oxygen and causes life threatening symptoms. To reverse the effects of carbon monoxide poisoning, carboxyhemoglobin needs to be removed by breathing high concentrations of oxygen. This hyperoxygenation can be achieved by HBOT.

HBOT and Decompression Sickness

Decompression sickness, also known as the bends, is caused by rising to the surface too fast while SCUBA or deep sea diving. During a dive, nitrogen from the breathing gas is absorbed by the body’s tissues. If the diver rises to the surface too fast and the pressure is reduced too quickly, the nitrogen will be absorbed by the body’s tissues in the form of large bubbles. These large gas bubbles can migrate to the body’s joints and bones causing pain. It can have a neurological effect with lower back pain, paralysis, numbness and “heavy” legs. If the large gas bubbles should present within the circulatory system an arterial gas emboli can develop in the lungs and or brain which can be fatal. HBOT treats this condition by decreasing the size of the nitrogen gas bubbles allowing them to be absorbed appropriately by the body.

Side effects of HBOT

Due to the level of pressure within the chamber and its effect on the human body there may be side effects to HBOT treatment. Two of the most common side effects of HBOT are middle ear barotrauma (ear pressure) and oxygen toxicity.

Middle ear barotrauma can lead to perforation of the ear drum. Some techniques used to manage the pressure on the ear are purposeful swallowing or yawning during the pressure change, or placement of tubes in the ear. Oxygen toxicity, excess oxygen in the body’s tissues, is another possible side effect. Symptoms can include tunnel vision, ringing of ears, nausea, twitching, irritability, dizziness, and seizures. One technique used by medical professionals to manage this is to have their patients breathe room air through a mask during treatment.


HBOT is currently being used as an adjunct therapy to treat a variety of conditions, including wound care. As with all elective procedures, medical professionals must weigh the positives vs. negatives to determine if HBOT is appropriate for the patient. The patient must be capable of being compliant with the treatment plan and medical professionals must be trained and knowledgeable in the treatment and associated equipment.

The healthcare experts at Robson Forensic are frequently retained to provide expert witness services concerning the quality of care provided by medical professionals.

For more information submit an inquiry or contact the author of this article.


Featured Expert

Christa A. Bakos, RN

Registered Nurse, Acute Hospital & Wound Care Expert

Christa Bakos is a Registered Nurse who specializes in acute care, with a specific emphasis on wound care. Her career in healthcare includes broader experience in outpatient care, critical care, case management, and acute care nursing. Christa applies her expertise to forensic casework evaluating the quality of patient care provided in medical facilities, residential facilities, outpatient wound clinics, and in the home.


  1. Kaur, S., Pawar, M., Banerjee, N., & Garg, R. (2012). Evaluation of the efficacy of hyperbaric oxygen therapy in the management of chronic nonhealing ulcer and role of periwound transcutaneous oximetry as a predictor of wound healing response: A randomized prospective controlled trial. Journal of Anaesthesiology Clinical Pharmacology, 70-75.
  2. Kindwall, E., & Whelan, H. (2017). Hyperbaric Medicine Practice 4th Edition. North Palm Beach, FL: Best Publishing Company.
  3. Opasanon, S., Pongsapich, W., Taweepraditpol, S., Suktitipat, B., & Chuangsuwanich, A. (2014). Clinical Effectiveness of Hyperbaric Oxygen Therapy in Complex Wounds. J Am Coll Clin Wound Spec. , 9-13.