Clinical Evidence Database
Hyperbaric oxygen therapy is recognized for multiple indications by the Undersea and Hyperbaric Medical Society (UHMS). Evidence levels range from gold-standard RCTs to emerging pilot studies.
The gold-standard treatment for decompression illness ("the bends") in divers. HBOT is the primary and universally accepted intervention.
Standard of care — UHMS, all diving medical authorities
Strong RCT evidence demonstrates HBOT reduces cognitive sequelae. Standard of care in many emergency departments across Canada.
Weaver et al., NEJM 2002 — Landmark RCT
Emergency indication for gas bubbles in arterial circulation. HBOT reduces bubble volume through Boyle's Law and accelerates gas reabsorption.
UHMS Emergency Indication — Universally accepted
One of the most common clinical HBOT uses. Includes diabetic foot ulcers, arterial insufficiency ulcers, and other non-healing wounds. Multiple RCTs support improved wound healing and reduced amputation risk.
Kranke et al., Cochrane 2015; Fedorko et al. 2016 ♦ — View studies · FAQ
Strong evidence for osteoradionecrosis, radiation cystitis, and radiation proctitis. HBOT promotes angiogenesis in radiation-damaged tissue.
Marx 1983 — Landmark study; UHMS Approved
Adjunctive to surgery and antibiotics for clostridial myonecrosis. HBOT inhibits toxin production and enhances immune function against anaerobic bacteria.
UHMS Approved — Adjunctive therapy
Time-sensitive adjunctive therapy for crush injuries, compartment syndrome, and acute traumatic ischaemias. Reduces edema and supports tissue viability.
UHMS Approved — Time-critical adjunct
Adjunctive to surgical debridement. HBOT enhances leukocyte killing, inhibits anaerobic organisms, and improves antibiotic penetration into infected tissue.
UHMS Approved — Adjunctive to surgery
Supports viability of compromised skin grafts and tissue flaps through enhanced oxygenation, promoting neovascularization in ischemic tissue beds.
UHMS Approved — Post-surgical adjunct
Adjunctive to antibiotics and surgery for chronic bone infections that resist conventional treatment. Enhances oxygen-dependent leukocyte bactericidal activity.
UHMS Approved — Adjunctive therapy
Recently added to the recognised conditions list. Growing evidence supports HBOT for idiopathic sudden hearing loss, particularly when combined with corticosteroids.
UHMS Approved — Added to indications list
When transfusion is impossible or blood loss is too great for the body to compensate, HBOT provides a bridge by dissolving oxygen directly into plasma, supporting tissue oxygenation until red blood cells can be restored.
UHMS Approved — Emergency/adjunctive therapy
Adjunctive to surgery and antibiotics for brain abscesses. HBOT enhances antibiotic penetration, supports leukocyte bactericidal activity, and reduces cerebral oedema in hypoxic brain tissue.
UHMS Approved — Adjunctive to surgery
Adjunctive therapy for severe burns. HBOT reduces oedema, supports tissue viability in the zone of stasis, enhances immune function, and may reduce the need for surgical intervention in selected cases.
UHMS Approved — Adjunctive to burn care
Active research area with mixed but promising RCT results. Particularly relevant to Canada's contact sports community. Studies suggest HBOT may promote neuroplasticity and reduce neuroinflammation.
Harch et al., J Neurotrauma 2012; Efrati et al. — View studies · FAQ
Israeli RCTs demonstrated measurable neurological improvements in chronic stroke patients, with researchers investigating whether HBOT may support neurological recovery in chronic stroke patients.
Efrati et al., PLoS ONE 2013 — View studies · FAQ
Growing interest post-pandemic with Israeli RCTs showing improvements in neurocognitive function and persistent symptoms following COVID-19 infection.
Hadanny et al., Scientific Reports 2022 — View studies · FAQ
A prospective RCT demonstrated HBOT can diminish fibromyalgia syndrome with improvements in pain thresholds, quality of life, and brain function on SPECT imaging.
Efrati et al., PLoS ONE 2015 — View studies · FAQ
Military-focused research ongoing with early evidence suggesting HBOT may help alleviate post-traumatic stress disorder symptoms through neuroplasticity mechanisms.
Active military research programs — Phase I/II trials
Growing use among professional athletes for accelerated muscle recovery, soft-tissue injury healing, and post-concussion rehabilitation. Studies suggest HBOT reduces inflammation markers and accelerates return-to-play timelines.
Ishii et al., J Sports Med 2005; multiple case series — See FAQ
Preliminary research suggests HBOT may improve symptoms of anxiety and depression through enhanced cerebral blood flow and neuroplasticity. Studies report improvements in cognitive function and mood regulation.
Hadanny et al., 2022 — Neurocognitive RCT; See FAQ
A landmark Israeli RCT demonstrated HBOT can lengthen telomeres and clear senescent cells in aging adults — two key biological hallmarks of aging — though clinical significance and long-term implications require further study.
Hachmo et al., Aging 2020 — Telomere RCT; See FAQ
Growing evidence supports HBOT as adjunctive therapy for refractory Crohn's disease and ulcerative colitis, particularly for perianal fistulae. Studies report improved healing rates and symptom reduction.
Dulai et al., Aliment Pharmacol Ther 2014; See FAQ
Note: The following conditions are under investigation with limited or preliminary evidence. HBOT for these indications is not currently supported by robust clinical data and should not be considered standard of care. Research is ongoing.
Canadian multicentre RCT (Collet et al., Lancet 2001) found improvements in both HBOT and control groups, creating ongoing debate about pressurized air effects.
Rossignol et al. (BMC Pediatrics 2009) showed modest improvements in some symptoms. Results remain debated and replication studies are needed.
Early studies generated interest but have not been consistently replicated. Current evidence insufficient to recommend HBOT for MS treatment.
Largely anecdotal evidence with no strong clinical trial support. Not an approved indication; patients should discuss with their healthcare provider.
Animal models and small human studies suggest HBOT may improve cerebral blood flow and reduce amyloid plaque burden. Clinical evidence remains preliminary and larger trials are needed.
Shapira et al., Neurobiol Aging 2021 — View studies
Limited but intriguing evidence from small trials showing improvements in fatigue severity, cognitive function, and quality of life. Mechanism may involve improved mitochondrial function and reduced neuroinflammation.
Akarsu et al., UHM 2013 — View studies
Preclinical and small clinical studies suggest HBOT may reduce secondary injury and promote functional recovery when administered in the acute or subacute phase. Human data remains limited.
Huang et al., J Neurosurg 2014 — View studies