Hyperbaric Oxygen Therapy Indications, 14th Edition

Also available as an ebook on: About the Book Since its first appearance in 1977, the UHMS Hyperbaric Oxygen Therapy Indications has served as a guide for practitioners and scientists interested in hyperbaric and undersea medicine. Past UHMS president Richard E. Moon, chair of the Hyperbaric Oxyg ...Read more
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About the Book

Since its first appearance in 1977, the UHMS Hyperbaric Oxygen Therapy Indications has served as a guide for practitioners and scientists interested in hyperbaric and undersea medicine.

Past UHMS president Richard E. Moon, chair of the Hyperbaric Oxygen Therapy Committee and editor for the 14th edition, along with additional Committee members and leading experts in the field, authored chapters in their respective fields. This publication continues to provide the most current and up-to-date guidance and support in hyperbaric medicine.

Updates in the 14th Edition

  • Revised and updated references
  • A new chapter summarizing recently published data on trails of HBO2 for chronic traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD)
  • Addition of flowcharts to specific chapters to aid in treatment of decision-making

Table of Contents

Members of the Hyperbaric Oxygen Therapy Committee
I. Background
II. Hyperbaric Oxygen: Definition
III. Utilization Review For Hyperbaric Oxygen Therapy
IV. Acceptance (Addition) of New Indications for Hyperbaric Oxygen Therapy
V. List of Abbreviations
VI. Author Biographies

PART I. Indications

1. Hyperbaric Treatment of Air or Gas Embolism: Current Recommendations
2. Arterial Insufficiencies
A. Central Retinal Artery Occlusion
B. Hyperbaric Oxygen Therapy for Selected Problem Wounds
3. Carbon Monoxide Poisoning
4. Clostridial Myonecrosis (Gas Gangrene)
5. The Effect of Hyperbaric Oxygen on Compromised Grafts and Flaps
6. The Role of Hyperbaric Oxygen for Acute Traumatic Ischemias
7. Decompression Sickness
8. Delayed Radiation Injuries (Soft Tissue and Bony Necrosis) and Potential for Future Research
9. Sudden Sensorineural Hearing Loss
10. Intracranial Abscess
11. Necrotizing Soft Tissue Infections
12. Refractory Osteomyelitis
13. Severe Anemia
14. Adjunctive Hyperbaric Oxygen Therapy in the Treatment of Thermal Burns

PART II. Additional Considerations

15. Mechanisms of Action of Hyperbaric Oxygen Therapy
16. Side Effects of Hyperbaric Oxygen Therapy
17. Oxygen Pretreatment and Preconditioning
18. Randomized Controlled Trials in Diving and Hyperbaric Medicine
19. Hyperbaric Oxygen for Symptoms Following Mild Traumatic Brain Injury

Appendix A. Approved Indications for HBO2 Therapy


The application of air under pressure (hyperbaric air) dates back to 1667, when Nathaniel Henshaw proposed a hypo-hyperbaric room pressurized and depressurized with an organ bellows.1 In the nineteenth century, Simpson wrote a treatise on the use of compressed air for certain respiratory diseases.2 The medicinal uses of oxygen were first reported by Beddoes in 1794,3 while the first article describing adjunctive uses of hyperbaric oxygen therapy (HBO2) was written by Fontaine in 1879,4 who constructed a mobile operating room which could be pressurized. He observed that pressurized patients were not as cyanotic after the use of nitrous oxide during induction of anesthesia as compared to patients anesthetized at atmospheric pressure. In addition, he noted that hernias were much easier to reduce. Also around that time, the work of Paul Bert5 and J. Lorrain-Smith6 showed that oxygen under pressure had potentially deleterious consequences on the human body with side effects that included central nervous system and pulmonary toxicity. The efforts of Churchill-Davidson and Boerema in the 1950s and 1960s spurred the modern scientific use of clinical hyperbaric medicine.

In 1967, the Undersea Medical Society was founded by six United States Naval diving and submarine medical officers with the explicit goal of promoting diving and undersea medicine. In short order, this society expanded to include those interested in clinical hyperbaric medicine. In recognition of the dual interest by members in both diving and clinical applications of compression therapy, the society was renamed The Undersea and Hyperbaric Medical Society in 1986. It remains the leading not for profit organization dedicated to reporting scientifically and medically efficacious and relevant information pertaining to hyperbaric and undersea medicine.

In 1972, an ad hoc Medicare committee was formed to evaluate the efficacy of hyperbaric oxygen therapy for specified medical conditions. The focus was to determine if this treatment modality showed therapeutic benefit and merited insurance coverage. The growth of the body of scientific evidence that had developed over the preceding years supported this endeavor and recognition for the field. In 1976, the Hyperbaric Oxygen Therapy Committee became a standing committee of what was then the UMS. The first Hyperbaric Oxygen Committee Report was published in 1977 and served as guidance for practitioners and scientists interested in HBO2. The report is usually published every three to five years and was last published in 2014. Additionally, this document continues to be used by the Centers for Medicare and Medicaid Services and other third party insurance carriers in determining payment.

The report, currently in its 14th edition, has grown in size and depth to reflect the evolution of the literature. To date, the committee recognizes 14 indications for which scientific and clinical evidence supports the use of HBO2.

The Undersea and Hyperbaric Medical Society continues to maintain its reputation for its expertise on hyperbaric therapy. With leading experts authoring chapters in their respective fields, this publication continues to provide the most current and up to date guidance and support for scientists and practitioners of hyperbaric oxygen therapy.

Richard E. Moon MD
Editor, UHMS Committee Chair


  1. Henshaw N. Aero-Chalinos or a register for the air for the better preservation of health and cure of diseases, after a new method. London. 1677.
  2. Simpson A. Compressed Air as a Therapeutic Agent in the Treatment of Consumption, Asthma, Chronic Bronchitis and Other Diseases. Edinburgh: Sutherland and Knox; 1857.
  3. Beddoes T, Watt J. Considerations of the Medicinal Use of Factitious Airs, and on the Manner of Obtaining Them in Large Quantities, First Edition, part II. Bristol: Bulgin and Rossier; 1794.
  4. Fontaine JA. Emploi chirurgical de l’air comprime. Union Med. 1879;28:445.
  5. Bert P. Barometric Pressure [Hitchcock MS, Hitchcock FA, translation]. Bethesda, MD: Undersea Medical Society; 1978. P. 579.
  6. Lorrain-Smith J. The pathological effects due to increase of oxygen tension in the air breathed. J Physiol. 1899; 24:19-35.

Members of the Hyperbaric Oxygen Therapy Committee

  • Richard Moon MD (Chair)
  • Dirk Bakker MD
  • Robert Barnes MD
  • Michael Bennett MD
  • Enrico Camporesi MD
  • Paul Cianci MD
  • James Clark MD
  • William Dodson, MD
  • John Feldmeier DO
  • Laurie Gesell MD
  • Neil B. Hampson MD
  • Brett Hart MD
  • Enoch Huang MD
  • Irving Jacoby MD
  • Robert Marx DDS
  • Heather Murphy-Lavoie MD
  • Richard Roller MD
  • Ben Slade MD
  • Michael Strauss MD
  • Stephen Thom MD, PhD
  • Keith Van Meter MD
  • Lindell Weaver MD
  • Wilbur T. Workman MS

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Undersea and Hyperbaric Medical Society (UHMS)
Richard E. Moon, MD
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