According to the Undersea & Hyperbaric Medical Society (UHMS), the internationally accepted scientific association in the field of Undersea (Diving) and Hyperbaric Medicine, the following indications are approved uses of Hyperbaric Oxygen Therapy (as defined by the Hyperbaric Oxygen Therapy Committee):

1. Air or Gas Embolism

2. Carbon Monoxide Poisoning and Carbon Monoxide Poisoning Complicated by Cyanide Poisoning

3. Clostridal Myositis and Myonecrosis (Gas Gangrene)

4. Crush Injury, Compartment Syndrome, and other Acute Traumatic Ischemias

5. Decompression Sickness

6. Enhancement of Healing in Selected Problem Wounds

7. Exceptional Blood Loss (Anemia)

8. Intracranial Abscess

9. Necrotizing Soft Tissue Infections

10. Osteomyelitis (Refractory)

11. Delayed Radiation Injury (Soft Tissue and Bony Necrosis)

12. Skin Grafts & Flaps (Compromised)

13. Thermal Burns

14. Idiopathic Sudden Sensorineural Hearing Loss (New! approved on October 8, 2011 by the UHMS Board of Directors)

 

 

The Ministry of Health and Social Solidarity of the Hellenic Republic, following an expert opinion from the Central Health Council, issued a Ministerial Act in 2010 (Υ4α/οικ. 27504 // 04/03/2010), concerning the “Determination of Approved Indications of Hyperbaric Oxygen Therapy & Cost of Therapy”, that includes:

1. Acute or Emergency Indicated Conditions, where HBO Therapy is expected to have a positive impact on survival or to prevent permanent organ damage. These include

• Carbon Monoxide Poisoning

• Decompression Sickness

• Gas Embolism

• Necrotizing (anaerobic) Infections

• Mixed Soft Tissue Infections in Immunocompromised Patients

• Crush Injury & Compartment Syndrome

• Burns

• Cases treated at ICUs or Surgical Departments that show acute tissue hypoxia, timely provision of HBO Therapy is expected to affect outcome significantly as well as prevent from functional deficiency eg Reperfusion Injury

• Sudden Deafness

2. Chronic Indicated Conditions, where HBO Therapy enhances immune and healing mechanisms of the tissues, when Oxygen transport to the tissues is inadequate:

• Lower Extremities Diabetic Ulcers

• Chronic Refractory Osteomyelitis

• Compromised Skin Grafts & Flaps

• Delayed Radiation Injury (Soft Tissue and Bony Necrosis)

• Post-radiation Cystitis

• Lower Extremities Peripheral Vascular Occlusive Disease (non-surgical)

• Problem wounds – Chronic Ulcers

• Deficient Callus Formation – Insufficient Bone Repair

 

 

The European Committee for Hyperbaric Medicine (ECHM), is the European scientific organization focused on the field of Diving & Hyperbaric Medicine. Last agreement on the recommended indications for HBO Therapy was announced after the 10th ECHM Consensus Conference that took place in Lille, 2016. Evidence-Based Medicine methodology was used that concluded the following categories:

Type 1 Indications - Strongly Indicated. HBOT is strongly indicated as a primary treatment method, as it is supported by sufficiently strong evidence:

• Anaerobic or Mixed Bacterial Infections

• Carbon Monoxide (CO) Poisoning

• Decompression Illness

• Gas Embolism

• Open Fractures with Crush Injury

• Prevention of Osteoradionecrosis after Dental Extraction

• Osteoradionecrosis (mandible)

• Soft Tissue Radionecrosis (cystitis, proctitis)

• Sudden Deafness

Type 2 Indications - Suggested. HBOT is suggested as it is supported by acceptable level of evidence:

• Burns, 2nd degree & more than 20% of body surface area (BSA)

• Central Retinal Artery Occlusion (CRAO)

• Compromised skin grafts and musculocutaneous flaps

• Crush Injury without Fracture

• Diabetic Foot Lesions

• Femoral Head Necrosis

• Ischemic Ulcers

• Neuroblastoma, stage IV

• Osteoradionecrosis (bones other than mandible)

• Pneumatosis Cystoides Intestinalis

• Radio-induced lesions of soft tissues (other than cystitis and proctitis)

• Refractory Chronic Osteomyelitis

• Surgery and Implant in Irradiated Tissue (preventive treatment)

Type 3 Indications - Optional. HBOT can be considered as a possible/optional measure, but it is not yet supported by sufficiently strong evidence:

• Brain Injury in Highly Selected Patients (Acute and Chronic TBI, chronic stroke, Post-anoxic Encephalopathy)

• Interstitial Cystitis

• Limb Replantation

• Post-vascular Procedure Reperfusion Syndrome

• Radio-induced lesions of the Larynx

• Radio-induced lesions of the CNS

• Selected non healing Wounds secondary to Systemic Processes

• Sickle Cell Disease

Type 1 Indications for not using HBOT

• Autism Spectrum Disorders

• Cerebral Palsy

• Multiple Sclerosis

• Placental Insufficiency

• Stroke, Acute Phase

• Tinnitus

 

 

There are various other conditions where hyperbaric oxygen is used, considered at the international level as “indications under investigation”. Hyperbaric Experts worldwide treat patients for such conditions because, although not included in the lists of indications, a big body of medical literature and experience supports positive results. Long personal experience treating various cases (reference centre for HBOT for more than half of the country’s population) has shown clearly that it is a unique powerful regimen for many of these. These conditions include:

• Diabetic foot (included in Enhancement of Healing in Selected Problem Wounds) – contributes to wound healing, treatment of possible underlying osteomyelitis and avoidance of amputation

• Avascular necrosis (AVN) or aseptic necrosis of the femoral head – avoidance of arthroplasty, resolution of lesions in most cases of stage I & II of AVN

• Nonunion and delayed union of fractures

• Sickle cell crisis and other hypoxic complications of sickle cell disease (lower extremities ulcers)

• Sport injuries – rehabilitation and quick return to action and work

• Transverse myelitis

• Neurologic conditions resulting from inflammation and local hypoxia – includes Bell’s palsy and other mononeuropathies

• Vascular pathology – Buerger’s disease, Raynaud’s syndrome

• In general, conditions where ischemia impedes normal body healing processes leading to insufficient wound healing (including systemic conditions like scleroderma, treatment for rheumatic diseases, thalasaemia etc), bone formation (cortisol, area of fracture, systemic conditions etc)

• Burns – faster oedema absorption, better skin restoration and reduced scar formation. Of special interest when cosmetic result is desirable (e.g. face)

• Inflammatory Bowel Disease and complications, and Pneumatosis Cystoides Intestinalis

• Pyoderma Gangrenosum

• Brown recluse spider bites