This review explains the method of action of hyperbaric oxygenation (HBO) therapy and examines the evidence for its use in trauma. Methods of delivery, complications and contra-indications are discussed. It is acknowledged that there are few controlled trials which evaluate the efficacy of HBO in this indication; supporting evidence for its efficacy is mainly in the form of case reports, or by implication from laboratory and animal work. Lack of evidence may not equate to lack of efficacy, but may reflect the difficulties in coordinating clinical trials involving critically ill patients and a complex treatment modality, the availability of which is not widespread. The adjunctive use of HBO has shown promising results in the treatment of crush injury. Consideration of tissue pathophysiology suggests that such an approach may also offer improved outcomes in the broader spectrum of trauma scenarios involving marginally viable tissues with compromised perfusion.
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