Evidence-Based Hyperbaric Medicine

Comprehensive clinical protocols and streamlined referral process for physician colleagues

Meet The TeamReview Clinical Protocols

14

FDA-Approved Indications

24/7

Emergency Consultation

98%

Prior Authorization Success

2-3 ATA

Treatment Pressures

Carbon Monoxide Poisoning
COHb ≥25% with symptoms OR <25% with neurologic deficits, cardiac ischemia, age ≥50, or metabolic acidosis
Emergency Indication
▼

Mechanism of Action

HBOT accelerates carboxyhemoglobin dissociation from 5-6 hours (room air) to approximately 25 minutes. Additionally provides neuroprotection through improved mitochondrial function, reduced lipid peroxidation, and decreased leukocyte adhesion to injured microvasculature.

Evidence Base

Weaver et al., New England Journal of Medicine 2002
Randomized controlled trial (N=152) demonstrating 46% reduction in cognitive sequelae at 6 weeks with HBOT treatment
American College of Emergency Physicians Guidelines 2025
Updated guidelines providing ER physician discretion for HBOT referral, noting modest benefit especially for memory impairment

Treatment Protocol

Pressure: 2.4-3.0 ATA
Duration: Single 2.5-hour treatment. Typically 1 session but may require additional sessions
Optimal timing: Within 24 hours of exposure
Note: 100% oxygen and supportive care remain primary treatment
Diabetic Lower Extremity Ulcers
Wagner Grade III-V ulcers with failed 30+ days standard wound care or acutely infected Wagner Grade III DFU that have required surgical intervention. Must document vascular assessment and glucose optimization.
FDA Approved
▼

Mechanism of Action

Reverses tissue hypoxia, stimulates angiogenesis, enhances fibroblast replication and collagen deposition, improves leukocyte bacterial killing capacity, and mobilizes circulating stem cells for tissue regeneration.

Wagner Grading Scale

Grade 3: Deeper tissues involved, with abscess, osteomyelitis, or tendinitis
Grade 4: Localized gangrene of toe or forefoot
Grade 5: Gangrene of foot (partial or total)

Documentation Note: While Wagner grading remains the formal criteria for HBO approval, many providers now use alternative terminology. Documented "fat pad exposed" meets criteria for Wagner Grade III representing more common clinical verbiage.

Evidence Base

Faglia et al., Diabetes Care 1996
Randomized trial showing reduction in major amputation rate from 33% to 8.5%
Kranke et al., Cochrane Review 2015
Meta-analysis demonstrating improved healing rates and reduced amputation risk

Treatment Protocol

Pressure: 2.0-2.5 ATA
Duration: Varies. 30-40 sessions, on average
Requirements: Concurrent optimal wound care, vascular assessment, glucose control
Monitoring: Weekly wound measurements required for continued coverage
Clinical Note: Treatment protocol pressures up to 2.5 ATA. Total sessions vary greatly depending on wound severity and response.
Sudden Sensorineural Hearing Loss
≥30 dB hearing loss over 3+ contiguous frequencies within 72 hours. Audiogram documentation required.
FDA Approved
▼

Mechanism of Action

Increases perilymph oxygen content to support high-metabolism cochlear structures. The organ of Corti has minimal direct vascular supply and depends on oxygen diffusion from capillary networks into perilymph.

Evidence Base

Bennett et al., Cochrane Review 2012
Moderate quality evidence for improved hearing recovery when combined with corticosteroids
Muzik et al., European Archives of Otorhinolaryngology 2007
Significant hearing improvement in refractory cases treated within 6 months

Recommended treatment by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

Treatment Protocol

Pressure: 2.4-2.6 ATA
Duration: 10-20 treatments
Optimal timing: Initial therapy is within 2 weeks of onset, and that of salvage therapy is within 1 month of onset of sudden sensorineural hearing loss
Concurrent therapy: Corticosteroids (oral or intratympanic)
Coverage: Most private insurance; Medicare typically denies
Radiation Tissue Injury
Delayed radiation effects including osteoradionecrosis, soft tissue necrosis, and preparation for dental procedures in irradiated tissues.
FDA Approved
▼

Clinical Applications

Osteoradionecrosis: Bone death from radiation, commonly affecting mandible
Soft tissue radionecrosis: Including radiation cystitis, proctitis
Prophylactic treatment: Pre/post dental procedures in irradiated fields
Laryngeal necrosis: Post-radiation therapy complication

Mechanism of Action

Promotes angiogenesis in irradiated hypovascular tissues, increases stem cell mobilization, enhances osteoclast and osteoblast function, and improves tissue oxygen gradients for healing.

Treatment Protocol

Pressure: 2.4-2.5 ATA
Duration: 20-40 treatments depending on indication
Prophylactic protocol: 20 treatments pre-surgery, 10 post-surgery
Coverage: Generally well-covered by insurance for established indications
Crush Injury/Compartment Syndrome
Acute vascular compromise including surgical compromise. Multi-tissue trauma with edema formation and tissue ischemia.
FDA Approved
▼

Mechanism of Action

Supplements oxygen availability to hypoxic tissues, increases tissue oxygen tensions for cellular function, induces vasoconstriction reducing edema by 20% while maintaining oxygen delivery through plasma dissolution, and mitigates reperfusion injury by inhibiting neutrophil adhesion.

Pathophysiology

Trauma leads to edema formation and tissue ischemia creating a self-perpetuating cycle. HBOT interrupts this edema-ischemia cycle and prevents progression of injury through multiple mechanisms including improved oxygen gradients and reduced inflammatory response.

Treatment Protocol

Pressure: ≥2.4 ATA
Duration: 10-20 treatments depending on response
Frequency: Daily or twice daily basis
Urgency: Time-sensitive - early intervention critical
Acute Peripheral Arterial Insufficiency
Acute limb ischemia with threatened tissue viability. Includes severe Raynaud's phenomenon and frostbite with tissue compromise.
FDA Approved
▼

Mechanism of Action

Increases tissue oxygenation to hypoxic and ischemic areas, reduces edema and inflammation, enhances leukocyte function and antimicrobial action, stimulates angiogenesis and tissue regeneration, and improves perfusion in vasospastic disorders.

Clinical Applications

Acute limb ischemia: Threatened tissue viability
Severe Raynaud's phenomenon: Refractory cases with tissue risk
Frostbite: Cold-induced tissue damage
Thermal burns: Partial thickness or deeper

Treatment Protocol

Pressure: ≥2.0 ATA
Duration: Case dependent, typically 10-30 treatments
Frequency: Daily or twice daily depending on acuity
Coverage: Many commercial carriers approve based on medical necessity

Non-FDA/Emerging Conditions

Research-supported applications with growing clinical evidence

Pre/Post Surgical Recovery
Enhanced healing and reduced complications for major surgeries
Emerging Evidence
▼

Clinical Applications

Pre-surgical optimization for high-risk patients, accelerated post-operative healing, reduction in surgical site infections, and enhanced recovery after orthopedic procedures.

Treatment Protocol

Pressure: Protocol varies based on latest research
Duration: Individualized based on surgical type
Timing: 5-10 sessions pre-surgery, 10-20 post-surgery
Concussion/Traumatic Brain Injury
Post-concussion syndrome and persistent neurological symptoms
Emerging Evidence
▼

Mechanism of Action

Reduces neuroinflammation, promotes neuroplasticity, improves cerebral blood flow, and supports mitochondrial recovery in injured brain tissue.

Treatment Protocol

Pressure: Protocol adjusted per ongoing research
Duration: 20-40 sessions based on severity
Monitoring: Neurocognitive assessments throughout treatment
Inflammatory Bowel Disease
Refractory Crohn's disease and ulcerative colitis
Emerging Evidence
▼

Clinical Applications

Treatment-resistant IBD, perianal Crohn's disease, fistulating disease, and adjunct to biological therapy.

Treatment Protocol

Pressure: Varies per research protocols
Duration: 30-40 sessions typical
Response monitoring: Clinical scores and inflammatory markers
Chronic Pain Syndromes
Complex regional pain syndrome, fibromyalgia
Emerging Evidence
▼

Mechanism of Action

Reduces inflammatory mediators, modulates pain signaling pathways, improves tissue oxygenation, and promotes endorphin release.

Treatment Protocol

Pressure: Individualized based on condition
Duration: 20-40 sessions
Assessment: Pain scales and functional measures

Clinical Indications and Evidence Base

Click to review diagnostic criteria, treatment protocols, and supporting research

Please complete all required fields and submit supporting documentation via fax (605) 743-0170

Patient Referral Submission

6300 S Lyncrest Ave, Sioux Falls, SD 57108

605-743-0402

Book Your Consult