Acute Thermal Burns

Severe thermal burns destroy skin and trigger swelling and reduced blood flow in the surrounding tissue, which can deepen the injury over the first days. Hyperbaric oxygen has been used as an adjunct to specialist burn care to limit this progression, reduce oedema and support healing. Acute thermal burn injury is on the UHMS list of approved indications, and the FDA has cleared hyperbaric chambers for severe and large burns treated at a specialised burn centre.

The clinical evidence is limited. A Cochrane review found two eligible randomised trials, both of poor methodological quality: one reported no difference in length of stay, mortality or number of operations, the other a shorter healing time (a mean of 19.7 versus 43.8 days). The reviewers concluded that there is not sufficient evidence to support or refute HBOT for thermal burns (Villanueva 2004). A 2026 systematic review of 13 studies (566 patients) concluded that HBOT shows promise as an adjunct, improving healing and reducing complications, but that variable and inconsistent outcomes limit definitive conclusions (Molina-Vega 2026).

US Medicare does not cover HBOT for thermal skin burns. Treatment protocols vary between burn centres and have not been standardised in trials.