HBO Threshold Levels

Last updated on 9/12/24 | First published on 10/25/17 | Literature review current through Jun. 2025 [cite]

Authors: Jeff Mize RRT, CHT, UHMSADS, Tiffany Hamm BSN, RN, CWS, ACHRN, UHMSADS, Elaine Horibe Song MD, PhD, MBA, Steven Orr MD, FACEP/UHM, FAPWCA, more...

INTRODUCTION

HBO Threshold Levels refer to the specific lower and upper limits of hyperbaric oxygen therapy (HBOT) treatment guidelines established by the Undersea and Hyperbaric Medical Society (UHMS). These levels are used to guide the utilization review and ensure that the therapy is administered within safe and effective boundaries. These threshold levels are categorized for different indications, such as elective-chronic and emergent-acute conditions.

HBO THRESHOLD LEVELS

Indications	Threshold Levels
	Lower Limit	Upper Limit / Utilization Review
Elective - Chronic
Chronic Refractory Osteomyelitis	20*	30-40‡
Diabetic Lower Extremity Ulcer	14	40
Intracranial Abscess	5	20‡
Late Radiation Tissue Prophylaxis	20*	30‡
Osteoradionecrosis - Mandibular	30*	60‡
Preparation of Wounds for Grafting	10	30‡
Problem Wound Support	14	30‡
Soft Tissue Radionecrosis	20*	60‡
Emergent – Acute
Acute Carbon Monoxide Poisoning		5‡
Acute Exceptional Blood Loss Anemia	Until satisfactory hematocrit or pt. stable, asymptomatic, or transfusion becomes possible
Acute Peripheral Ischemias	3*	14‡
Central Retinal Artery Occlusion		**‡
Acute Thermal Burns	5*	30‡
Cerebral Arterial Gas Embolism		10‡
Clostridial Myonecrosis (Gas Gangrene)	5*	10‡
Compromised Skin Grafts and Flaps, digit/limb replantation	6*	20‡
Decompression Sickness		10‡
Necrotizing Soft Tissue Infections	10*	30‡
Reattachment Limb/Digits	5	30
Selected Invasive Fungal Infections	7	20
Idiopathic Sudden Sensorineural Hearing loss	1	20

Modified from National Baromedical Services [1]

* If the patient receives less than the indicated lower treatment threshold, a case audit is to be undertaken. For these disorders, too few treatments may be unlikely to have sufficient therapeutic effect and potentially waste resources. Reasons for early termination of HBO therapy may include: death; misdiagnosis; non-compliance; deterioration, or failure to perceive improvement.

** For patients treated more than three days after clinical plateau.

‡ Recommendations of the Undersea and Hyperbaric Medical Society, Hyperbaric Oxygen therapy Indications 13th Edition, 2014

For Tables and respective indications, see HBO Treatment Indication with Protocol
For HBO Treatment Tables, see HBO Treatment Tables

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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.

REFERENCES

National Baromedical Services. Introduction to Hyperbaric Medicine Primary Training Manual .;.

Topic 67 Version 1.0

HBO Threshold Levels

HBO Threshold Levels

INTRODUCTION

HBO THRESHOLD LEVELS

Elective - Chronic

Emergent – Acute

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