WoundReference improves clinical decisions
 Choose the role that best describes you
WoundReference logo

HBOT for Chronic Refractory Osteomyelitis - An Overview

HBOT for Chronic Refractory Osteomyelitis - An Overview

HBOT for Chronic Refractory Osteomyelitis - An Overview


This topic is part of a series for clinicians who are considering referring patients to a hyperbaric oxygen therapy (HBOT) center for treatment consideration. It provides an overview on adjunctive HBOT for chronic refractory osteomyelitis. A printable PDF that can be customized with the facility contact information is included.

What is Hyperbaric Oxygen Therapy?

The Undersea and Hyperbaric Medical Society defines hyperbaric oxygen therapy as an intervention in which an individual breathes 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure (1 atmosphere absolute, or ATA). For clinical purposes, the pressure must equal or exceed 1.4 ATA while breathing near 100% oxygen. 

How the Intervention Works

The air we breathe has approximately 21% oxygen at 14.7 pounds of pressure per square inch (psi) when measured at sea level. In the hyperbaric chamber, the atmospheric pressure can be increased to as much as 3 times normal (about 44.1 psi), with the patient breathing 100% oxygen. This increases the amount of oxygen in the blood plasma to many times its normal levels. Higher oxygen levels are delivered to end organ tissues throughout the body.

Rationale for Treatment

Refractory osteomyelitis is a chronic osteomyelitis that persists or recurs after appropriate interventions have been performed, or where acute osteomyelitis does not respond to accepted management techniques. Hyperbaric oxygen, when combined with appropriate antibiotics, nutritional support, surgical debridement and reconstruction, provides a useful clinical adjunct in the management of refractory bone infections. Addition of hyperbaric oxygen to appropriate clinical management produces an infection arrest rate of nearly 80%. 

HBOT Benefits

Hyperbaric oxygen benefits healing by enhancing bacterial killing activity of white blood cells. 

  • Certain antibiotics require an oxygen-mediated pathway in order to transport the medication across bacterial walls. 
  • There is evidence that osteogenesis and osteoclast remodeling is an oxygen-dependent activity. 
  • Osteomyelitis is characterized by both acute and chronic forms of hypoxia. Hyperbaric oxygen raises tissue levels of oxygen, decreases edema, decreases tissue hypoxia, enhances neovascularization, and supports new collagen and bone formation. 

Hyperbaric Criteria for Treatment

Failure to resolve following surgical debridement and appropriate antibiotics regimen of 4-6 weeks preferably selected from appropriate culture and sensitivity information, drainage of abscesses, suitable immobilization of the affected part and debridement with the removal of infected bone.

Treatment Course

  • 2.0 to 2.5 ATA for 90 minutes of oxygen breathing. 
  • Treatments are usually provided daily
  • 20-40 HBOT sessions will be required to achieve sustained therapeutic benefit

Official reprint from WoundReference® woundreference.com ©2024 Wound Reference, Inc. All Rights Reserved
Use of WoundReference is subject to the Subscription and License Agreement. ​
NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.


  1. Worth E, Hamm T, Mize J, (2019) et al. An Introduction to Hyperbaric Oxygen Therapy . 2020;.
Topic 1527 Version 1.0