Which Burns Qualify for HBOT? Burn Degree, Electrical Burns, and Inhalation Injury

Not every burn needs HBOT. For minor burns and superficial injuries, standard wound care is the right approach. HBOT enters the picture for serious burns where tissue oxygenation is a limiting factor in healing.

Thermal Burns by Degree

First-degree burns affect only the outer skin layer. Think sunburn. Painful, red, no blisters. HBOT is not indicated for first-degree burns.

Second-degree burns split into two categories:

Superficial second-degree burns (partial thickness) affect the outer layers and part of the dermis. They blister, are very painful, and typically heal in 2-3 weeks with standard wound care. HBOT generally isn’t used here.

Deep second-degree burns (deep partial thickness) reach further into the dermis, reduce sensation (nerve endings are damaged), and heal much more slowly. If healing is poor after initial wound care, HBOT may be used as an adjunct.

Third-degree burns (full thickness) destroy all skin layers and often the tissue beneath. The surface may look white, brown, or leathery. Pain can paradoxically be less than second-degree because nerve endings are destroyed. Third-degree burns require skin grafting and are where HBOT has the most clinical application.

Fourth-degree burns extend into muscle and bone. The most severe category. HBOT is used adjunctively as part of a complex treatment plan.

Electrical Burns

Electrical burns are a separate category from thermal burns and they’re treated differently. HBOT is considered standard adjunct care at many burn centers for significant electrical injury.

Here’s why. Electrical injury looks deceptively minor at the entry and exit wounds. The real damage is inside — electrical current travels through the body and damages muscle, nerves, and blood vessels deep in the tissue, sometimes throughout entire limbs. The surface wound doesn’t show the true extent of injury.

This deep tissue injury creates extensive hypoxia in areas that can’t be reached by topical treatments. HBOT addresses deep tissue oxygen deficits that standard wound care can’t reach. The mechanism is similar to crush injury, which HBOT is also used to treat.

Electrical burn patients need cardiac monitoring (electrical current can cause arrhythmias) and should be evaluated for myoglobinuria from muscle breakdown before HBOT candidacy is assessed. Your burn center team will coordinate this.

Inhalation Injury

Smoke inhalation combines two injury types:

CO poisoning from carbon monoxide in smoke. When CO poisoning criteria are met (see CO poisoning HBOT criteria), HBOT is indicated for that component.

Thermal airway injury from heat and toxic chemicals in smoke can cause airway swelling and lung injury. HBOT may be used for its anti-inflammatory and tissue oxygenation effects in these patients, often alongside treatment for the CO component.

How HBOT Helps Burns

HBOT addresses several limiting factors in serious burn healing:

Edema reduction: burn wounds produce significant swelling. Studies show HBOT reduces edema in burn wound margins, which improves perfusion and reduces fluid shifts.

Bacterial load: high oxygen tension is directly bactericidal against anaerobic organisms, which thrive in hypoxic wound beds. Reducing infection risk in an open burn wound matters significantly.

Angiogenesis: HBOT promotes new blood vessel growth in the wound margins, improving oxygen delivery to healing tissue.

Cianci et al. (1988) demonstrated decreased hospital stays and reduced skin graft requirements in burn patients treated with adjunctive HBOT. PMID: 3382225. This study is widely cited as foundational evidence for HBOT in burns.

HBOT Isn’t Used at Every Burn Center

Burn care protocols vary by institution. Some major burn centers integrate HBOT routinely for third-degree and electrical burns. Others don’t, either because they lack a chamber or because their clinical protocols take a different approach.

If you or someone you care for is being treated at a burn center and you want to know whether HBOT is part of the protocol, ask directly. If the center you’re at doesn’t offer HBOT, transfer to a facility that does may be appropriate for complex cases — your burn team can advise on this.

Insurance Coverage

Serious burns are an FDA-approved indication for HBOT. Insurance may cover it when the burn meets clinical criteria. Verify with the treating facility’s billing team.

FAQ

Q: Which burns qualify for HBOT? Third-degree thermal burns, significant electrical burns, and burns with CO poisoning or inhalation injury. First-degree burns don’t qualify. Second-degree burns may qualify if deep and healing poorly.

Q: Why is HBOT used for electrical burns? Electrical injury causes deep tissue damage not visible at the surface. HBOT delivers oxygen to deep hypoxic tissue that topical care can’t reach.

Q: Does HBOT help smoke inhalation? Yes. For the CO poisoning component and for thermal/toxic airway injury.

Q: Is burn HBOT covered by insurance? It’s FDA-approved. Verify specific coverage with your facility’s billing team.

Related: Burns and HBOT | Insurance Coverage for HBOT

Medical Disclaimer: This content is for informational purposes only and does not constitute medical advice. Serious burns require immediate emergency medical care. HBOT for burns is an adjunct to standard burn care, not a replacement. Always consult your burn care team about your specific situation. This site does not establish a doctor-patient relationship.