Thermal burns present a multifactorial tissue injury that culminates in a marked inflammatory response with vascular derangement from activated platelets and white cell adhesion with resultant edema, hypoxia, and vulnerability to severe infection. Poor white cell function caused by the local environment exacerbates this problem. Hyperbaric oxygen therapy (HBOT) addresses each of these pathophysiological derangements, and can, therefore, make a significant difference in patient outcomes. These mechanisms of action have been discussed above.
Multiple animal studies support the utility of HBOT for treatment of thermal burns.
Human studies ranging from case series to randomized clinical trials have supported the potential benefit of HBOT in burn treatment. These include a small randomized study by Hart that demonstrated improved healing and decreased mortality. Niezgoda showed increased healing in a standardized human burn model. In a series of publications, Cianci suggests significant reduction in length of hospital stay, need for surgery, and cost.
Because of the goals of therapy, HBOT is begun as soon as possible after injury, with a goal of three treatments within the first 24 hours and then twice daily. Length of treatment depends on the clinical impairment of the patient and the extent of and response to grafting. Special attention must be given to fluid management and chamber and patient temperature to avoid undue physiologic stress to the patient as well as potential complications of treatment (ie, oxygen toxicity).