Asia
Hyperbaric
Centre
Who Is
This For?
This supportive protocol is for people with significant thermal burns — scalds, flame, contact burns — whose burn specialist recommends hyperbaric oxygen as an adjunct to their care, ideally beginning within the first 24 hours [1] [2].
It is most appropriate for:
Deep second-degree (partial-thickness) burns: The depth where the zone of stasis is largest — and where the evidence shows the clearest effect on healing time and conversion to deeper injury [1] [3].
Burns covering significant body surface area: The larger the burn, the greater the swelling and fluid losses — and the studies show the strongest effects exactly here: less resuscitation fluid, less oedema, shorter stays [3] [5] [6].
Burns heading toward grafting: Better-preserved tissue at the margin can mean less grafting needed and better graft take where grafting proceeds [3] [6] [7].
Inhalation or airway involvement: Managed jointly with the burn centre — these cases are coordinated, never improvised [1].
Superficial burns do not need this protocol. Significant ones, referred early, are where it belongs. A doctor's referral is required — here, it will come from your burn surgeon or emergency physician, and we coordinate directly with them.
In the first 24 hours. That is when the zone of stasis hangs in the balance, and when the trials showing benefit delivered their sessions [1] [2] [3].
Hyperbaric oxygen should be discussed with the burn team when:
A significant partial-thickness burn has just occurred — within hours is best, within a day is still the evidence window [3] [4].
Swelling and fluid losses are running high, where reduced oedema directly changes the resuscitation burden [3] [5].
The burn's true depth is still declaring itself, and preserving marginal tissue could prevent conversion to full-thickness injury [1] [2].
Grafting is being planned, where better tissue condition changes what the surgery can achieve [6] [7].
One caution, stated plainly: hyperbaric oxygen is an adjunct to a burn centre, never a substitute for one. Airway, fluids, wound care, and surgery come first — our role begins alongside them [1] [2].
When to Consider HBOT
Defending the Zone of Stasis
A burn is not one wound — it is three concentric ones. At the centre, tissue destroyed on contact. Around it, the zone of stasis: injured, swollen, barely perfused, still alive. Around that, healthy skin reacting to the inflammation. The battle for a burn's final size is fought in that middle ring [1] [2].
The enemy there is a familiar cycle. Swelling raises tissue pressure. Pressure collapses micro-vessels. Starved of oxygen, marginal tissue dies — and the burn claims new ground. Meanwhile the whole body leaks fluid through injured vessels, driving the massive resuscitation volumes that carry their own risks [1] [2].
Inside the chamber, we change the physics. At 2.0 to 2.5 ATA, 99.5% medical-grade oxygen dissolves directly into the blood plasma, bypassing red blood cells entirely [1]. Two effects follow, and they work together.
First, oedema control. High oxygen tension constricts healthy vessels — reducing inflow and fluid leakage into the swollen tissue — while the plasma still carries abundant oxygen. Controlled human studies show wound swelling and exudation fall measurably [2] [8]. Clinically, that translates into roughly a third less resuscitation fluid required in the major series [3] [5].
Second, margin survival. The oxygen-saturated plasma perfuses the zone of stasis through its struggling micro-circulation, keeping the cells alive through the critical 24 to 48 hours while new vessels grow in. Tissue that would have converted to full-thickness loss survives as partial-thickness — and partial-thickness heals [1] [2].
The Science & Clinical Evidence
We do not make promises. The research does that — and on this page, it also shows its seams, because burn evidence is genuinely mixed and you deserve to see the whole picture.
The strongest controlled trial was sham-controlled and randomized: burn patients received hyperbaric oxygen or simulated sessions, with fluids and wound care standardised [3]:
19.7 vs 43.8 days — mean healing time with hyperbaric oxygen versus control (P < .001). — Hart et al., Surgery, Gynecology & Obstetrics, 1974 [3]
~35% — the reduction in resuscitation fluid required in the same trial — a finding echoed by the largest clinical series, which reported 30–35% lower fluid requirements. — Hart et al., 1974 [3]; Niu et al. [5]
266 vs 609 — the large outcome series comparing seriously burned patients treated with and without adjunctive hyperbaric oxygen, reporting significantly lower mortality in the hyperbaric group (P = .028). — Niu et al. [5]
Burn-centre series add consistent operational findings: shorter hospital stays (up to 53% reduction), fewer surgeries (86% reduction in one centre's series), and — in one often-misread "negative" study — a 75% reduction in the need for grafting in the hyperbaric group [6] [7] [9].
Where we are honest with you: the Cochrane review examined the randomized trials and concluded the evidence is insufficient to recommend or refute routine use — heterogeneity and small samples prevented firm conclusions [10]. A 1997 randomized trial found no benefit [11]. The pattern across half a century is consistent in direction — less oedema, less fluid, less surgery, faster healing — but it rests on small trials and large series, not the mega-trials this difficult population has never produced [1] [2]. The UHMS recognises acute thermal burn as an approved adjunctive indication [1], and we present it to your burn team exactly that way: promising, mechanistically sound, and honestly incomplete.
Our protocols follow the trial structures and UHMS guidance for acute thermal burns [1] [3]. In the acute phase, the schedule belongs to the burn team's plan — dressing changes, procedures, fluid management.
Oxygen Purity: 99.5% Medical-Grade Oxygen — pharmaceutical-grade purity certified under the Pharmacy and Poisons Ordinance (Cap. 138) [12].
Chamber Pressure: 2.0 to 2.5 ATA (Atmospheres Absolute) — the range used across the burn literature [3] [4].
Session Duration: 90 minutes at depth.
Frequency (acute phase): Up to two to three sessions in the first 24 hours where indicated, then twice daily or daily as the wound stabilises — the early window carries the evidence [3] [4].
Total Course: Varies with burn size and response — from a short acute course to daily sessions across the healing period, set jointly with your burn team [1] [3].
The Protocol
What To Expect
We understand that entering a hyperbaric chamber can feel unfamiliar. Our team is here to guide you through every step of the process, ensuring you feel comfortable, safe, and supported.
Step 1 — The Briefing & Preparation: Before your first session, our technician will walk you through the safety protocols. You will change into 100% cotton clothing (provided) to eliminate static risk. No electronics, watches, or oil-based cosmetics are allowed inside the chamber.
Step 2 — Pressurisation: As the chamber pressurises over 10-15 minutes, you will feel a sensation in your ears similar to descending in an airplane. Our technician will coach you on simple techniques to clear your ears. Once at depth (2.0-2.4 ATA), you will breathe 99.5% pure oxygen through a comfortable hood or mask. You can read, rest, or watch a screen during the 90-minute session.
Step 3 — Depressurisation & Next Steps: The chamber will slowly depressurise over 10-15 minutes. Once open, you can return to your normal daily activities immediately. Our technician will examine your wound site and coordinate with your primary wound care team to track your progress.
FAQ
How many sessions before I notice a difference?
The acute course is short — the trials that showed benefit began within the first day and ran intensively through the first week [3] [4]. Swelling and wound appearance usually respond within the first several sessions. For larger burns, daily sessions may continue across the healing period, always jointly decided with your burn team.
Can hyperbaric oxygen treat my burn instead of the burn centre?
No — and we will never frame it that way. Fluid resuscitation, wound care, and surgery are the treatment. Hyperbaric oxygen is an adjunct that the evidence suggests can reduce how much of each you need [1] [3] [5]. Every session we run for a burn is coordinated with the specialist team managing your care.
Is the evidence strong enough to justify adding this?
Honestly framed: the direction of half a century of evidence is consistent — less swelling, less fluid, fewer operations, faster healing [1] [2] [3] — but the randomized trials are small and the Cochrane review calls the overall evidence inconclusive [10]. The UHMS nonetheless recognises it as an approved adjunct [1]. Whether it fits your burn is a decision for your burn surgeon, with the full picture in front of them. We will provide that picture, including its gaps.
UHMS. Acute Thermal Burn Injury. UHMS Hyperbaric Oxygen Therapy Indications, 15th Edition. Undersea and Hyperbaric Medical Society. UHMS Official Indications
Cianci P, et al. Thermal burns and hyperbaric oxygen (mechanism review: zone of stasis, oedema control, conversion prevention). Undersea Hyperb Med. 2013;40(1). UHMS Journal
Hart GB, et al. Treatment of burns with hyperbaric oxygen (sham-controlled randomized series). Surg Gynecol Obstet. 1974;139:693-696. [UNVERIFIED — exact volume/pages to be confirmed before publication; healing time 19.7 vs 43.8 days verified against UHMS review]
Niezgoda JA, et al. Hyperbaric oxygen in a human burn model: reduced wound size, hyperemia and exudate (randomized double-blind sham-controlled). 1997. [UNVERIFIED — full citation to be confirmed before publication]
Niu AKC, et al. Large clinical outcome series of hyperbaric oxygen in serious burns (266 vs 609; mortality reduction, P = .028; fluid requirements reduced 30–35%). As reviewed in Cianci et al., UHM 2013 [2]. [UNVERIFIED — primary citation to be confirmed before publication]
Cianci P, et al. Adjunctive hyperbaric oxygen in the treatment of thermal burns (reduced hospital stay, surgeries and cost; J Burn Care Rehabil. 1989-1990 series). [UNVERIFIED — exact citations to be confirmed before publication]
Waisbren BA, et al. Hyperbaric oxygen in burn management: a controlled study (75% reduction in grafting need, P < .001). 1982. As reviewed in [2]. [UNVERIFIED — full citation to be confirmed before publication]
Hammarlund C, et al. Hyperbaric oxygen in a controlled human blister-wound model: reduced oedema and exudation. 1991. As reviewed in [2]. [UNVERIFIED — full citation to be confirmed before publication]
Maxwell GP, et al. Controlled pilot series: reduced surgery, ICU days, wound sepsis and cost with adjunctive hyperbaric oxygen. 1991. As reviewed in [2]. [UNVERIFIED — full citation to be confirmed before publication]
Villanueva E, et al. Hyperbaric oxygen therapy for thermal burns. Cochrane Database of Systematic Reviews. 2009. As reviewed in [2]. [UNVERIFIED — exact issue to be confirmed before publication]
Brannen AL, et al. A randomized prospective trial of hyperbaric oxygen in burn injury (no demonstrated benefit). J Burn Care Rehabil. 1997;18(4):289-294. [UNVERIFIED — exact citation to be confirmed before publication]
Hong Kong e-Legislation. Pharmacy and Poisons Ordinance (Cap. 138). Cap. 138 on e-Legislation
