Reading time: 8 minutes. Last updated: 20 May 2026.
TL;DR: Canadian referring physicians should know three things this spring: (1) Health Canada continues to licence hyperbaric oxygen therapy only for 14 indications aligned with the Undersea and Hyperbaric Medical Society, (2) the UHMS 15th Edition Indications Manual is now in publication with new dosing guidance and an additional recognised indication, and (3) recent meta-analyses on carbon monoxide poisoning, burns, glioma, head and neck reconstruction, and traumatic brain injury have shifted the evidence base in ways that should inform your referral decisions in 2026.
Hyperbaric oxygen therapy is a medical treatment in which patients breathe 100 percent oxygen inside a pressurised chamber at 1.5 to 3.0 atmospheres absolute. In Canada, it remains regulated by Health Canada under the Medical Devices Regulations, with 14 approved clinical indications aligned to the Undersea and Hyperbaric Medical Society. This spring roundup, prepared by Canada Hyperbarics, summarises the regulatory updates, new systematic reviews, and association developments that referring physicians should be aware of before sending a patient for hyperbaric assessment.
What is the current Canadian regulatory status of hyperbaric oxygen therapy?
Health Canada continues to licence hard-shelled hyperbaric chambers under Class III of the Medical Devices Regulations, restricted to the 14 indications recognised by the Undersea and Hyperbaric Medical Society. No soft-shelled or mild hyperbaric device has received a Health Canada medical device licence as of May 2026, and Health Canada has reiterated through its recall and alerts portal that unlicensed soft-shelled chambers may pose serious health risks.
For referring physicians, the practical implication is straightforward. A referral pathway is supported when the indication falls within the 14 licensed conditions and the receiving facility uses a Health Canada licensed chamber. For off-label use, the standard medical-legal protections that apply elsewhere in Canadian practice apply here too: documented informed consent, a clear clinical rationale, and a chart record showing that approved alternatives were considered.
Which indications does Health Canada currently recognise?
The current 14 indications, unchanged in scope through May 2026, are best summarised in the following reference table. Many of these have substantial supporting evidence; others are supported on the basis of pathophysiology and observational data alongside randomised trials.
| Indication category | Typical referral urgency | Evidence strength |
|---|---|---|
| Air or gas embolism | Emergent (hours) | Strong (mechanistic plus case series) |
| Carbon monoxide poisoning | Emergent (within 24 hours) | Re-evaluated by 2026 meta-analysis |
| Decompression sickness | Emergent | Strong (long-standing standard of care) |
| Necrotising soft tissue infections | Urgent (alongside surgery) | Moderate (adjunct) |
| Gas gangrene (Clostridial myonecrosis) | Urgent | Moderate |
| Crush injury and acute traumatic ischaemia | Urgent (within 24 hours) | Moderate |
| Delayed radiation injury | Elective | Strong |
| Non-healing diabetic foot ulcers | Elective | Moderate |
| Compromised grafts and flaps | Urgent | Moderate |
| Chronic refractory osteomyelitis | Elective | Moderate |
| Severe anaemia (when transfusion impossible) | Emergent | Limited (rare scenarios) |
| Intracranial abscess | Urgent | Moderate |
| Thermal burns | Urgent (selected cases) | Reviewed in 2026 evidence update |
| Idiopathic sudden sensorineural hearing loss | Urgent (within 2 weeks) | Moderate (most effective early) |
A full annotated list with referral notes is maintained on the conditions index, and Canadian regulatory background is summarised on the regulatory page. For the original Health Canada position, see the Health Canada hyperbaric oxygen therapy overview.
What does the UHMS 15th Edition Indications Manual update mean for referrers?
The Undersea and Hyperbaric Medical Society is releasing the 15th Edition of its Hyperbaric Medicine Indications Manual, the international reference text that Canadian regulators and insurers most often defer to. The 15th Edition includes three changes relevant to Canadian referring physicians:
- An expanded chapter on dosing of hyperbaric oxygen, addressing pressure, treatment duration, frequency, and cumulative course length. This is the first formal UHMS guidance on dosing aggregated across indications.
- Updated chapters on all 14 existing indications, incorporating systematic reviews published since 2019.
- A new chapter on an additional indication approved by the UHMS Oxygen Therapy Committee. Canadian referring physicians should expect Health Canada to consider this addition, although the formal licensing pathway in Canada lags behind UHMS recognition by 12 to 24 months on average.
Until Health Canada formally extends its licensed indications, a new UHMS indication remains off-label in Canada. That does not preclude referral but does require the standard informed-consent and documentation framework. The Canadian Undersea and Hyperbaric Medicine Association maintains a national standards-of-practice document that aligns with UHMS guidance.
What does the 2026 carbon monoxide poisoning meta-analysis change in practice?
A January 2026 systematic review and meta-analysis published in Acute Medicine and Surgery by Fujita and colleagues reassessed the evidence for hyperbaric oxygen in acute carbon monoxide poisoning. The pooled analysis of six randomised controlled trials found no statistically significant benefit of hyperbaric oxygen over normobaric oxygen on mortality or neurological outcomes, including in the subgroup using pressures at or above 2.5 ATA. The authors graded the quality of evidence as low to very low.
For Canadian emergency physicians, this does not remove carbon monoxide poisoning from the list of recognised indications. UHMS, the European Committee for Hyperbaric Medicine, and Health Canada all continue to recognise it. The clinical reality is that referral remains appropriate for symptomatic patients with carboxyhaemoglobin levels above 25 percent, loss of consciousness, neurological signs, cardiac involvement, or pregnancy, and the treatment should still be initiated within 24 hours of exposure. The shift is in tone: the certainty of benefit is weaker than once thought, and emergency physicians should counsel patients accordingly. A full summary is available at our internal study page: Evaluating HBOT for acute carbon monoxide poisoning (2026) (PubMed).
What new evidence should inform oncology and surgical referrals?
Three 2026 systematic reviews are particularly relevant to surgical and oncology referrers.
Glioma and chemoradiotherapy
A March 2026 meta-analysis of nine randomised controlled trials covering 837 glioma patients found that concurrent hyperbaric oxygen therapy with chemoradiotherapy was associated with significantly improved objective tumour response rates and improved three-year overall survival, with benefits consistent across hyperbaric pressures and session durations. The effect remains preliminary and requires confirmation in large multicentre Phase 3 trials, but it strengthens the case for considering hyperbaric oxygen referral in selected glioma patients alongside their radiation oncology plan. Full summary: Concurrent HBOT with chemoradiotherapy for glioma (2026 meta-analysis) (PubMed).
Head and neck reconstruction
A May 2026 systematic review and meta-analysis of 42 studies covering 2,448 patients and over 10,000 implants in irradiated bone reported significantly higher dental implant survival in patients who received adjunctive hyperbaric oxygen therapy (risk ratio 1.47, 95 percent confidence interval 1.06 to 2.03). This reinforces the long-standing delayed radiation injury indication and provides quantified evidence for head and neck surgeons coordinating with prosthodontic teams. Full summary: Implant survival and HBOT in head and neck oncology (2026) (PubMed).
Burn care
A May 2026 systematic review across 13 burn studies and 566 patients found trends toward reduced surgical need, shorter hospital stays, improved healing, and lower infection risk with hyperbaric oxygen adjunct, although mortality benefits remain inconsistent. Burn centre directors and plastic surgeons coordinating with regional hyperbaric services may find this evidence useful in case selection. Full summary: HBOT in burn care: 2026 systematic review (PubMed).
What does the June 2026 traumatic brain injury sleep review tell physicians?
A June 2026 systematic review and meta-analysis evaluated non-pharmacologic therapies for sleep disturbances after traumatic brain injury, including cognitive behavioural therapy, hyperbaric oxygen, blue-wavelength light therapy, and repetitive transcranial magnetic stimulation. Evidence for hyperbaric oxygen specifically was rated very low, with small samples and significant heterogeneity precluding definitive conclusions. The review also flagged a higher relative risk of mild ear barotrauma in hyperbaric oxygen groups compared to sham (relative risk 2.66).
For referring physicians considering hyperbaric oxygen for post-TBI sleep symptoms specifically, the appropriate framing is that this remains an emerging indication, not a Health Canada or UHMS recognised one. Cognitive behavioural therapy for insomnia has the strongest evidence in this population. Full summary: Non-pharmacologic therapies for post-TBI sleep (2026) (PubMed).
What should referring physicians document before sending a patient?
The Canadian referral pathway is straightforward for recognised indications. The following documentation is typically requested by hospitals and regulated facilities in Canada:
- Confirmed diagnosis with supporting investigations (laboratory values, imaging, microbiology as appropriate).
- Indication-specific clinical staging or severity grade.
- List of attempted standard treatments and outcomes.
- Cardiopulmonary screening: a recent chest X-ray, ECG, and pulmonary function if any history of bullous disease, COPD, or recent thoracic surgery.
- Otologic clearance for patients with chronic ear disease.
- Confirmation of contraindication screening: untreated pneumothorax, certain chemotherapy agents (bleomycin, cisplatin within recent windows), and unstable epilepsy.
- Patient consent for hyperbaric assessment.
A referral pathway directory by province is maintained in the coverage section, and a step-by-step physician guide is maintained at About Canada Hyperbarics. For the directory of hospitals and regulated facilities currently operating across Canada, see the facilities directory.
Frequently asked questions from referring physicians
Has Health Canada recognised any new HBOT conditions in 2026?
No. As of May 2026, Health Canada continues to licence hyperbaric chambers for the 14 indications aligned with the Undersea and Hyperbaric Medical Society. New UHMS indications typically take 12 to 24 months to reach formal Health Canada licensing.
Can I refer a patient for an off-label hyperbaric indication?
Yes, with the standard medical-legal protections that apply to any off-label referral in Canada. Document the clinical rationale, ensure that the patient understands the indication is off-label, and confirm that approved alternatives have been considered. The receiving hyperbaric facility will also complete its own consent process.
How urgent is a carbon monoxide referral now that the 2026 meta-analysis is less favourable?
The recommended window of within 24 hours of exposure has not changed. Carbon monoxide poisoning remains a recognised indication. The 2026 meta-analysis lowers the certainty of benefit but does not remove the standard-of-care role of hyperbaric oxygen in symptomatic, high-risk presentations.
What is the time window for sudden sensorineural hearing loss referral?
Two weeks from symptom onset gives the strongest evidence for benefit, with treatment within 14 days the standard. Outcomes diminish significantly after four to six weeks. Patients should be referred at the same time corticosteroids are initiated, not after a failed steroid trial.
Is hyperbaric oxygen therapy covered by provincial health plans for referred patients?
Coverage varies by province. OHIP covers HBOT in Ontario at hospitals and a small number of eligible private facilities. MSP in British Columbia covers Vancouver General Hospital only. AHCIP in Alberta covers Alberta Health Services hospital clinics in Calgary and Edmonton. RAMQ in Quebec covers hospital-based services. MSI in Nova Scotia covers QEII Health Sciences Centre. For other provinces, hospital-based services may be covered when accessible. See the coverage page for the current provincial breakdown.
Where can I see new HBOT evidence as it is published?
Canada Hyperbarics maintains a continuously updated research database with over 14,000 indexed PubMed studies on hyperbaric oxygen therapy, organised by condition and filterable by year. For the original literature, the Undersea and Hyperbaric Medical Society publishes regular position statements, and the PubMed HBOT search returns all new indexed publications.
What are the most common reasons hyperbaric facilities decline a referral?
The most common reasons are: undocumented absolute contraindications (untreated pneumothorax, recent bleomycin), missing cardiopulmonary clearance, indication outside the approved list without an off-label discussion, and otologic conditions that have not been screened. A short discussion with the receiving facility before formal referral usually resolves these issues.
Where can Canadian physicians refer patients for hyperbaric oxygen therapy?
Canada Hyperbarics maintains a current directory of hospitals and regulated facilities offering hyperbaric oxygen therapy across the country, indexed by province and by indication. The facilities directory includes contact information, accreditation status, and the indications each facility treats. Physicians considering referral should call the receiving facility directly to confirm capacity and the current intake process.
For specific clinical questions, the FAQ includes physician-oriented answers, and the master conditions index provides condition-specific evidence summaries.
This content is for informational purposes only and does not constitute medical advice. Treatment decisions should always be made by qualified Canadian medical professionals based on individual patient circumstances. According to PubMed, the cited systematic reviews are reproduced here for educational purposes; consult the original publications and your local hyperbaric facility for clinical decision-making.