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A significant and consistently positive body of evidence from animal and human studies of thermal injury supports the use of hyperbaric oxygen as a means of preventing dermal ischemia, reducing edema, modulating the zone of stasis, preventing partial- to full-thickness conversion, preserving cellular metabolism and promoting healing. The vast majority of clinical reports have shown reduction in mortality, length of hospital stay, number of surgeries and cost of care. Hyperbaric oxygen has been demonstrated to be safe in the hands of those thoroughly trained in rendering this therapy in the critical care setting and with appropriate monitoring precautions. Careful patient selection is mandatory.

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A significant and consistently positive body of evidence from animal and human studies of thermal injury support the use of hyperbaric oxygen as a means of preventing dermal ischemia, reducing edema, modulating the zone of stasis, preventing partial- to full-thickness conversion, preserving cellular metabolism and promoting of healing. The vast majority of clinical reports have shown reduction in mortality, length of hospital stay, number of surgeries and cost of care. Hyperbaric oxygen has been demonstrated to be safe in the hands of those thoroughly trained in rendering therapy in the critical care setting and with appropriate monitoring precautions. Careful patient selection is mandatory.

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INTRODUCTION: Most cases of decompression sickness (DCS) in the U.S. are treated with hyperbaric oxygen using U.S. Navy Treatment Tables 5 and 6, although detailed analysis shows that those tables were based on limited data. We reviewed the development of these protocols and offer an alternative treatment table more suitable for monoplace chambers that has proven effective in the treatment of DCS in patients presenting to our facility. METHODS: We reviewed the outcomes for 140 cases of DCS in civilian divers treated with the shorter tables at our facility from January 1983 through December 2002. RESULTS: Onset of symptoms averaged 9.3 h after surfacing. At presentation, 44% of the patients demonstrated mental aberration. The average delay from onset of symptoms to treatment was 93.5 h; median delay was 48 h. Complete recovery in the total group of 140 patients was 87%. When 30 patients with low probability of DCS were excluded, the recovery rate was 98%. All patients with cerebral symptoms recovered. Patients with the highest severity scores showed a high rate of complete recovery (97.5%). DISCUSSION: Short oxygen treatment tables as originally described by Hart are effective in the treatment of DCS, even with long delays to definitive recompression that often occur among civilian divers presenting to a major Divers Alert Network referral center.

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There have been many advances in the treatment of wounds made in the last decade. Innovative techniques of wound closure, topical agents, aggressive vascular repair, focused wound care management, and adjunctive hyperbaric oxygen therapy are but a few of these improvements. The vital role of oxygen in wound healing is becoming better understood, in no small part, due to Dr. T. K. Hunt and his colleagues at the Wound Healing Laboratory at the University of California, San Francisco. Elements of that contribution will be examined in this article. How these elements may be applied to improve wound healing will be explained and the possible role of adjunctive hyperbaric oxygen therapy based on sound science in the management of the difficult diabetic foot wound, will be highlighted.

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