Thermal burn injuries, if not fatal, can cause disastrous long-term physical and emotional disability for the survivor. Especially in closed space fires, thermal and smoke (products of combustion) damage to the lungs can occur, requiring in some cases intubation and use of a mechanical ventilator. Burn injuries characteristically progress to become deeper and more extensive with time. Peak damage occurs within 3-4 days after the initial burn, and can be up to 10 times worse than the initial burn injury. In more severe and/or extensive burns (deep second, third and fourth degree burns), multiple aggressive surgeries are generally necessary to excise the burned tissue and later perform skin grafts to cover these areas. Burn injuries can result in lifelong difficulties, physical limitations, loss of job and employment opportunities, and significant disfigurement as the body heals from the injury. In many cases, the burn victim’s life is radically changed, literally overnight. The psychiatric adjustments can be overwhelming. When possible, these injuries should be treated in centers that specialize in the management of thermal burns. Adjunctive hyperbaric oxygen (HBO2) therapy has been shown to limit the progression of the burn injury, reduce swelling, reduce the need for surgery, diminish lung damage, shorten the hospitalization, and result in significant overall cost savings. These benefits are more apparent if therapy is initiated within 6-24 hours of the burn injury. Ideally, the patient should have 3 sessions in the first 24 hours, twice daily treatments until the process stabilizes, then continued therapy as indicated for healing enhancement and to support grafted areas.
Indications for HBO2 therapy typically include deep second-degree and third-degree burns that involve greater than 20% of the total body surface area, and less extensive burns that involve the face, hands or groin area. Best results are realized when HBO2 is used as an integral part of an aggressive multidisciplinary approach to the management of this potentially fatal injury. HBO2 is a very safe therapy even in seriously injured patients when administered by those thoroughly trained in HBO2 therapy in the critical care setting and with appropriate monitoring precautions.