Do not Use Hyperbaric Oxygen Therapy in Burns
Travis L. Perry MD
James H. Holmes IV MD
Hyperbaric oxygen therapy is currently used in various clinical treatment regimens. These include decompression sickness, carbon monoxide poisoning, cyanide poisoning, gas embolus, gas gangrene, resistant anaerobic infections, and threatened split-thickness skin grafts. The mechanism of action purportedly involves increasing tissue oxygenation, which increases collagen and fibroblast formation and suppresses Clostridia toxin production. It also enhances the killing ability of the leukocyte and capillary proliferation. This mechanism has primarily been established in animal models and limited human trials. At best, hyperbaric oxygen in the management of soft tissue infections can be promoted only as part of a coordinated medical and surgical approach.
It has been postulated that hyperbaric oxygen in burn wounds potentially exhibits some benefit by stimulating vasoconstriction and counteracting hypoxia. This theory is based on the possibility that hyperbaric oxygen may decrease acute edema, fluid requirements, and infection rates and promote re-epithialization. There have been several animal models that demonstrated varied results. However, the use and efficacy of hyperbaric oxygen in burn wound therapy is not established. Recent studies have not been able to demonstrate a statistically significant difference in the length of hospital stay, the number of operations required, and morbidity and/or mortality when comparing hyperbaric oxygen supplementation versus standard burn therapy. Thus, hyperbaric oxygen has no place in the acute management of thermal injuries.