Regulatory Framework

FDA-Approved Indications

The Undersea and Hyperbaric Medical Society (UHMS) recognizes 14 conditions for which HBOT is approved as a standard-of-care treatment, with evidence levels ranging from A (strong RCT evidence) to B (observational/expert consensus).

Acute Ischemias

1 Level A

Acute Ischemias

Air or Gas Embolism

Intravascular gas bubbles causing arterial obstruction. HBOT reduces bubble volume and promotes nitrogen elimination.

Standard of Care
4 Level A

Acute Ischemias

Crush Injury & Compartment Syndrome

Reduces post-ischemic edema, preserves threatened tissue, and accelerates healing in traumatic crush injuries.

Standard of Care
12 Level B

Acute Ischemias

Compromised Skin Grafts & Flaps

Salvage therapy for ischemic skin grafts and flaps. Reduces hypoxic necrosis and promotes graft survival through enhanced oxygenation.

Standard of Care

Toxicities

2 Level A

Toxicities

Carbon Monoxide Poisoning

HBOT accelerates CO elimination from hemoglobin and cytochrome oxidase, preventing delayed neurological sequelae.

Standard of Care

Infectious Diseases

3 Level A

Infectious Diseases

Clostridial Myositis & Myonecrosis (Gas Gangrene)

HBOT is directly lethal to Clostridium perfringens and inhibits toxin production, used adjunctively with surgery and antibiotics.

Standard of Care
7 Level B

Infectious Diseases

Exceptional Blood Loss Anemia

When transfusion is not possible due to religious beliefs or unavailability, HBOT provides sufficient dissolved plasma oxygen to sustain life.

Standard of Care
8 Level B

Infectious Diseases

Intracranial Abscess

Adjunctive therapy for brain abscesses, particularly those caused by anaerobic organisms. Enhances antibiotic efficacy and immune response.

Standard of Care
9 Level A

Infectious Diseases

Necrotizing Soft Tissue Infections

Adjunctive treatment for necrotizing fasciitis and Fournier's gangrene, reducing mortality and tissue loss when combined with surgery.

Standard of Care
10 Level A

Infectious Diseases

Refractory Osteomyelitis

Chronic osteomyelitis unresponsive to conventional therapy. HBOT enhances leukocyte killing, promotes angiogenesis in avascular bone.

Standard of Care

Gas/Bubble Disorders

5 Level A

Gas/Bubble Disorders

Decompression Sickness

Primary treatment for nitrogen bubble formation in divers and compressed-air workers. Reduces bubble volume and promotes nitrogen elimination.

Standard of Care

Wound Healing

6 Level A

Wound Healing

Enhancement of Healing in Selected Problem Wounds

Adjunctive treatment for chronic non-healing wounds, particularly diabetic foot ulcers with transcutaneous oxygen measurements <40 mmHg.

Standard of Care
11 Level A

Wound Healing

Delayed Radiation Injury (Soft Tissue & Bony Necrosis)

Treatment for osteoradionecrosis and soft tissue radiation necrosis. Promotes angiogenesis in hypoxic, hypovascular, hypocellular tissue.

Standard of Care

Sensory Disorders

13 Level B

Sensory Disorders

Idiopathic Sudden Sensorineural Hearing Loss

Adjunctive treatment when corticosteroids fail. Reverses cochlear hypoxia and reduces endolymphatic hydrops.

Standard of Care
14 Level B

Sensory Disorders

Central Retinal Artery Occlusion

Emergency treatment to preserve retinal layers and improve visual acuity through reversal of retinal ischemia.

Standard of Care

All 14 indications are recognized by the Undersea and Hyperbaric Medical Society (UHMS) and covered by Medicare/Medicaid in the United States. Evidence levels follow UHMS grading criteria.