Hyperbaric Oxygen Therapy for Burns
HBOT is FDA-approved as an adjunct treatment for thermal burns. Learn what the evidence shows, which burn patients may benefit, and what treatment involves.
Hyperbaric Oxygen Therapy for Burns
The FDA has cleared hyperbaric oxygen therapy (HBOT) as an adjunctive treatment for thermal burns. It works alongside standard burn care, not as a replacement for it.
Burns are among the most serious injuries a person can sustain. HBOT is one tool that some burn centers use to support tissue survival and improve healing outcomes. This page explains how it works, what the evidence shows, and who may benefit. You can also read our overview of what HBOT is to understand the basics.
How Burns Damage Tissue
A burn doesn’t just destroy surface tissue. It creates damage in layers.
Doctors describe three zones of burn injury. The innermost zone (the zone of coagulation) is the most severely burned tissue. It’s typically beyond saving. The outermost zone (the zone of hyperemia) is mildly affected and usually heals on its own.
The middle zone is what HBOT targets. It’s called the zone of stasis. This tissue isn’t dead, but it’s at serious risk. Blood flow is impaired. Oxygen delivery drops. Inflammation builds up. Without intervention, this tissue can progress to full tissue death over the hours and days after a burn.
Edema (swelling) makes this worse. As fluid accumulates, it further restricts circulation and oxygen delivery to cells that are already struggling.
How HBOT Is Used in Burn Care
HBOT is always used alongside standard burn care. Standard care includes fluid resuscitation, wound debridement, infection management, and skin grafting when needed.
Inside a hyperbaric chamber, you breathe 100% oxygen at increased atmospheric pressure. This dissolves extra oxygen directly into your blood plasma, getting it to tissues that compromised blood vessels can’t adequately supply.
In burn patients, this extra oxygen works through several mechanisms. It helps stabilize cell membranes and reduce fluid leakage, limiting edema in the damaged tissue. It delivers oxygen to the zone of stasis before that at-risk tissue progresses to full necrosis. It also restores the killing power of white blood cells, which need oxygen to fight bacteria in the wound. And it drives the cellular processes required for new tissue formation and graft survival, which may reduce scarring from poor wound closure.
HBOT sessions for burn patients are typically scheduled twice daily early in treatment, then once daily as the patient stabilizes. Sessions run 90 to 120 minutes at 2.0 to 2.4 atmospheres absolute (ATA). Total treatment is usually 15 to 30 sessions depending on the severity and response.
See our cost guide for information on what treatment involves financially.
What the Evidence Shows
HBOT for burns is FDA-approved. But the research base is thinner here than for indications like carbon monoxide poisoning or non-healing wounds.
Villanueva et al. published a Cochrane systematic review in 2004 examining the evidence from randomized controlled trials. The reviewers found that the mechanistic rationale for HBOT in burns is sound, but that available RCT evidence at the time was insufficient to draw firm conclusions. They called for larger, well-designed trials. (PMID: 15494998)
Cianci and Sato (1994) published a widely referenced clinical review of HBOT as an adjunct in thermal burn treatment. They described the mechanisms and summarized the clinical evidence supporting its use, noting meaningful reductions in fluid requirements and length of hospital stay in treated patients. (PMID: 8148913)
The clinical experience among burn specialists who have access to hyperbaric facilities is largely positive. But the absence of large RCTs means HBOT for burns isn’t universally adopted or offered. You’ll find it most often at major burn centers that have hyperbaric units on-site.
Who May Benefit
HBOT for burns isn’t used for every burn patient. It’s most commonly considered for:
- Partial and full-thickness burns involving more than 20% of total body surface area (TBSA)
- Burns to high-risk areas including the hands, face, and genitals
- Burns in patients with conditions that impair healing, such as diabetes or immune disorders
- Elderly patients where healing is naturally slower
- Cases where skin grafts are planned or at risk of failure
HBOT is also an FDA-approved treatment for compromised skin grafts and flaps, which is a common part of burn care. See our skin grafts and flaps page for more on that indication.
If you’re a burn patient or caring for one, ask the burn care team whether HBOT is available and appropriate for your situation. Not every facility has hyperbaric capabilities, and access varies significantly.
For information on coverage, visit our insurance guide. Also browse our conditions overview for other approved HBOT uses.
Frequently Asked Questions
Is HBOT a standard treatment for burns?
It’s FDA-approved as an adjunctive treatment, but it’s not offered at every burn center. It’s most available at major burn centers that have hyperbaric facilities on-site. Ask your burn care team if it’s an option where you’re being treated.
Does HBOT replace skin grafting?
No. HBOT is used alongside standard burn care, including skin grafting. It may improve graft survival and wound healing outcomes, but it doesn’t replace the graft itself.
What’s the evidence for HBOT in burns?
HBOT for burns is FDA-approved, but large randomized controlled trials are limited. A 2004 Cochrane review found the mechanistic rationale sound but called for more RCTs. Many burn specialists who have access to hyperbaric facilities report positive clinical outcomes.
Can HBOT help with burn scars?
Research on HBOT for existing burn scars is limited. HBOT may reduce scar formation by supporting better initial wound healing, but it’s not an established treatment for scars that have already formed.
References:
- Villanueva E, et al. Hyperbaric oxygen therapy for thermal burns. Cochrane Database Syst Rev. 2004. PMID: 15494998.
- Cianci P, Sato R. Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns: a review. Burns. 1994;20(1):5-14. PMID: 8148913.
Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.