Hyperbaric oxygen therapy accelerates burn healing and preserves threatened tissue
Hyperbaric oxygen therapy accelerates burn healing and preserves threatened tissue
Understanding thermal burn injuries and why hyperbaric oxygen therapy improves outcomes
Thermal burns are classified by depth: superficial (first degree), partial thickness (second degree) and full thickness (third degree). Serious burns cause injury beyond the visible wound — surrounding tissue becomes ischemic due to microvascular thrombosis and edema, creating a “zone of stasis” where cells are damaged but potentially salvageable if perfusion is restored quickly.
Without intervention, cells in the zone of stasis die, converting a partial-thickness burn into a deeper, more severe injury. This secondary progression of burn depth is a major driver of complications, longer hospitalizations and the need for skin grafting. HBOT targets this process directly by restoring oxygen to ischemic tissue in the zone of stasis before irreversible cell death occurs.
HBOT also addresses two other major causes of burn morbidity: infection and edema. Burns destroy the skin barrier, creating ideal conditions for bacterial invasion. HBOT reconstitutes the immune cell killing capacity impaired by tissue hypoxia and directly inhibits anaerobic bacteria. It also reduces edema through vasoconstriction, improving perfusion pressure in swollen burn tissue.
Important — scope of care at Bay Area Hyperbarics: Patients with severe, acute or life-threatening thermal burns require the resources of a hospital-based burn center equipped for round-the-clock surgical intervention, critical care monitoring and emergency management. Bay Area Hyperbarics provides adjunctive HBOT for patients who are in the ongoing healing phase of their burn recovery — those who are medically stable, whose acute care needs have been met and who are seeking HBOT in a warm, safe and comfortable outpatient environment as part of a comprehensive healing plan.
A note about insurance coverage: While many insurance companies cover HBOT for this condition, we cannot guarantee that your specific plan will cover treatment. Coverage depends on your specific policy and plan terms, the diagnosis code from your referring physician, your insurer’s medical necessity criteria, prior authorization approval, in-network status, and other plan-specific factors. Our Patient Care Coordinators will advocate on your behalf — please speak with them at or before your consultation so we can verify your benefits and request prior authorization on your behalf.
Deep partial-thickness and full-thickness burns with ischemic tissue at the wound margins
Burns covering more than 20% total body surface area
Burn wounds with significant surrounding edema limiting perfusion
Burns complicated by infection, particularly anaerobic organisms
Delayed or stalled burn wound healing requiring additional intervention
Burns requiring grafting, where HBOT can improve graft take rates
How HBOT improves outcomes in serious burn injuries
Burns leave tissue in a delicate, oxygen-deprived state where secondary damage can be as harmful as the original burn. HBOT attacks each of the main mechanisms of secondary burn progression.
Halts secondary burn depth progression
Reduces burn wound edema
Fights burn wound infection
Improves skin graft take rates
Accelerates wound healing and reduces scarring
Reduces hospital stay and surgical interventions
For Providers
Clinical evidence for HBOT in thermal burns
HBOT for thermal burns is a Medicare-approved indication with clinical evidence supporting its use as an adjunct to standard burn care for serious burns.
Reduction in burn depth progression: Hart et al. conducted a prospective randomized controlled trial published in the Annals of Emergency Medicine (1974) demonstrating that HBOT significantly reduced burn wound depth progression and fluid requirements in patients with serious burns. Patients treated with HBOT required less fluid resuscitation and had lower rates of wound infection. [Hart GB et al. Ann Emerg Med. 1974;3(2):87–90]
Preservation of the zone of stasis: Niezgoda et al. reviewed the mechanisms by which HBOT prevents secondary dermal ischemia in burns, noting that HBOT-treated animals showed significantly less conversion of partial- to full-thickness injury. This tissue-preserving effect reduces the ultimate depth and extent of injury. [Niezgoda JA et al. Wound Repair Regen. 1997;5(1):18–24. PMID: 17177740]
Infection reduction: Burns create a hypoxic wound environment that impairs neutrophil oxidative killing of bacteria. HBOT restores tissue oxygen to levels that reconstitute leukocyte bactericidal activity, reducing infection rates. Cianci et al. reported in the Journal of Burn Care and Rehabilitation that HBOT-treated burn patients had significantly reduced infection rates and shortened hospital stays. [Cianci P et al. J Burn Care Rehabil. 1988;9(6):546–551. PMID: 3146936]
Reduced length of stay and cost: Cianci and Sato published an analysis in Burns (1994) showing that HBOT as an adjunct to burn care reduced average hospital stays by up to 35% and reduced the number of surgical procedures required, generating significant cost savings over standard care alone. [Cianci P, Sato R. Burns. 1994;20(1):26–32. PMID: 8148879]
Improved graft outcomes: HBOT improves skin graft take rates in burn patients by restoring perfusion in the recipient wound bed. Multiple clinical series have reported improved graft adherence and reduced graft failure rates with perioperative HBOT. The UHMS recognizes thermal burns as an approved indication for adjunctive HBOT.
Our thermal burn HBOT protocol at Bay Area Hyperbarics
HBOT is an adjunct to standard burn care — not a replacement. We work alongside your burn care team to integrate HBOT into your overall treatment plan. Patients with severe, life-threatening burns are treated in hospital-based burn centers equipped for round-the-clock surgical intervention, intensive monitoring and emergency management; that is the appropriate setting for acute, critical burn injury. Bay Area Hyperbarics sees patients who are in the ongoing healing phase of their recovery — those who are medically stable, have had their acute needs addressed and are looking for a safe, comfortable, outpatient environment to receive HBOT as part of a comprehensive healing plan. We work closely with your burn center, wound care team and physician to ensure continuity of care throughout your recovery.
Assessment and burn care team coordination
Our medical team reviews your burn severity, total body surface area affected, infection status and current treatment plan. We coordinate directly with your burn center or wound care team to ensure HBOT complements your existing care rather than interrupting it.
Daily high-pressure oxygen sessions to preserve tissue and fight infection
You breathe 100% oxygen at 2.0 to 2.4 atmospheres absolute for approximately 90 minutes per session. Acute burns may require two sessions per day in the early phase. Treatment typically spans 10 to 30 sessions depending on burn severity and healing response.
Monitoring wound healing and supporting surgical procedures
We track wound depth, infection markers and tissue granulation throughout treatment. If skin grafting or surgical debridement is planned, we provide perioperative HBOT sessions to maximize tissue viability and graft take rates.
Frequently Asked Questions
Answers to the questions burn patients and families most often ask about hyperbaric oxygen therapy.
HBOT is most beneficial for serious burns: deep partial-thickness and full-thickness burns, burns covering more than 20% of total body surface area, and burns complicated by infection. Superficial burns typically heal well without HBOT. Our team will assess whether your burn severity warrants adjunctive HBOT treatment.
Recovering from a serious burn? Ask us about HBOT
Bay Area Hyperbarics provides adjunctive HBOT for serious burn injuries in coordination with your burn care team. Call us to find out whether HBOT is right for your treatment plan.
