HBO Therapy in Burns and Smoke Inhalation Injury


Since the first report of successful use of hyperbaric oxygen (HBO) therapy in burn and smoke inhalation victims by the well-known thoracic surgeon Professor Wada in Japan in 1965, [1, 2], there has been a controversy in the burn surgeon community concerning the possible benefits and dangers of HBO as a drug. Despite a number of well-controlled experimental studies on the effects of this powerful and fascinating drug, i.e. oxygen inhaled at pressure, no prospective and controlled study has been made at at any major burn care center; the main reason being the cumbersome method of administering the drug, i.e. the need for a hyperbaric chamber and personnel trained in HBO- and burn intensive care. Thus, many practitioners and scientists are still unaware of the potentials of HBO therapy in burn care.


Hyperbaric Oxygen Hyperbaric Oxygen Therapy Inhalation Injury Smoke Inhalation Carbon Monoxide Poisoning 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wada J, Ikeda K, Kamata K et al. (1965) Oxygen hyperbaric treatment for carbon monoxide poisoning and severe burn in a coal mine ( Hokutan-Yubari) gas explosion. Igakunoayumi (Japan) 54: 68Google Scholar
  2. 2.
    Ikeda K, Ajiki H, Nagao et al. (1970) Experimental and clinical use of hyperbaric oxygen in burns. In: Wada J, Iwa T (eds), Proc 4th International Congress on Hyperbaric Medicine. Balliere-Tindall and Cassel. London 377–380Google Scholar
  3. 3.
    La Van FB, Hunt TK (1990) Oxygen and wound healing. Clin Plast Surg 17: 463–472Google Scholar
  4. 4.
    Cianci P, Sato R (1994) Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns: a review. Burns 20: 5–14PubMedCrossRefGoogle Scholar
  5. 5.
    Hardy KR, Thom SR (1994) Pathophysiology and treatment of carbon monoxide poisoning. Clin Toxico132: 613–629Google Scholar
  6. 6.
    Arturson G (1985) The pathophysiology of severe thermal injury. J Burn Care Rehabil 6: 129–146PubMedCrossRefGoogle Scholar
  7. 7.
    Boykin JV, Eriksson E, Pittman RN (1980) In vivo microcirculation of scald burn and the progression of postburn dermal ischaemia. Plast Reconstr Surg 66: 191–198PubMedCrossRefGoogle Scholar
  8. 8.
    Xia Z-F, Coolbaugh MI, He F et al. (1992) The effect of burn injury on the acute phase response. J Trauma 32: 245–251PubMedCrossRefGoogle Scholar
  9. 9.
    Kowal-Vern A, Gamelli RL, Walenga JM et al. (1992) The effect of burn wound size on hemostasis: a correlation of the hemostatic changes to the clinical state. J Trauma 33: 50–57PubMedCrossRefGoogle Scholar
  10. 10.
    Deitch EA (1990a) The management of burns. N Engl J Med 323: 1249–1253PubMedCrossRefGoogle Scholar
  11. 11.
    Friedl HP, Till GO, Trentz O et al. (1989) Roles of histamine, complement and xantin oxidase in thermal injury of skin. Am J Pathol 135: 203–217PubMedGoogle Scholar
  12. 12.
    LaLonde C, Knox J, Youn YK et al. (1992) Burn edema is accentuated by a moderate smoke inhalation injury in sheep. Surgery 112: 908–917PubMedGoogle Scholar
  13. 13.
    Demling R, Lalonde C,Youn YK et al. (1995) Effect of graded increases in smoke inhalation injury on the early systemic response to a body burn. Crit Care Med 23: 171–178PubMedCrossRefGoogle Scholar
  14. 14.
    Moore FD Jr, Davis C, Rodrick M et al. (1986) Neutrophil activation in thermal injury as assessed by increased expression of complement receptors. N Engl J Med 314: 948–953PubMedCrossRefGoogle Scholar
  15. 15.
    Dobke MK, Deitch EA, Harner TJ et al. (1989) Oxidative activity of polymorphonuclear leucocytes after thermal injury. Arch Surg 124: 856–859PubMedCrossRefGoogle Scholar
  16. 16.
    Cioffi WG Jr, Burleson DG, Jordan BS et al. (1992) Granulocyte oxidative activity following thermal injury. Surgery 112: 860–865PubMedGoogle Scholar
  17. 17.
    Vindenes H, Bjerknes R (1994) Activation of polymorphonuclear neutrophilic granulocytes following burn injury: alterations of FC-receptor and complement-receptor expression and of opsonophagocytosis. J Trauma 36: 161–167PubMedCrossRefGoogle Scholar
  18. 18.
    Weiss SJ (1989) Tissue destruction by neutrophils. N Engl J Med 320: 365–376PubMedCrossRefGoogle Scholar
  19. 19.
    Anderson BO, Brown JM, Harken AH (1991) Mechanism of neutrophil mediated tissue injury. J Surg Res 52: 170–176CrossRefGoogle Scholar
  20. 20.
    Ferguson MK, Seifert FC, Replogle RL (1982) Leukocyte adherence in venules of rat skeletal muscle following thermal injury. Microvasc Res 24: 34–41PubMedCrossRefGoogle Scholar
  21. 21.
    Bone RC et al. (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–874CrossRefGoogle Scholar
  22. 22.
    Cioffi WG Jr, Burleson DG, Pruitt BA (1993) Leukocyte response to injury. Arch Surg 128: 1260–1267PubMedCrossRefGoogle Scholar
  23. 23.
    Xia Z-F, He F, Barrow RE et al. (1991) Reperfusion injury in burned rats after delayed fluid resuscitation. J Burn Care Rehabil 12: 430–436PubMedCrossRefGoogle Scholar
  24. 24.
    Schuelen J, Munster A (1982) The Parkland formula in patients with burns and inhalation injury. J Trauma 22: 869–874CrossRefGoogle Scholar
  25. 25.
    Navar P, Saffle J, Warden G (1985) Effect of inhalation injury on fluid resuscitation requirements after thermal injury. Am J Surg 150: 716–720PubMedCrossRefGoogle Scholar
  26. 26.
    Herndon DN, Barrow RE, Traber DL et al. (1987) Extravascular lung water changes following smoke inhalation and massive burn injury. Surgery 102: 341–349PubMedGoogle Scholar
  27. 27.
    Herndon DN, Traber DL, Traber LD (1986) The effect of resuscitation on inhalation injury. Surgery l00: 248–251Google Scholar
  28. 28.
    Artz CP (1967) Electrical injury simulates crush injury. Surg Gynecol Obstet 125: 13–16Google Scholar
  29. 29.
    Gutierrez G, Palizas F, Doglio G et al. (1992) Gastric intramucosal pH as a therapeutic index of tissue oxygenation in critically ill patients. Lancet 339: 195–199PubMedCrossRefGoogle Scholar
  30. 30.
    Chang MC, Cheatham ML, Rutherford EJ et al. (1994) Gastric tonometry supplements information provided by systemic indicators of oxygen transport. J Trauma 36: 153–159CrossRefGoogle Scholar
  31. 31.
    Tokyay R, Zeigler ST, Traber DL et al. (1993) Postburn gastrointestinal vasoconstriction increases bacterial and endotoxin translocation. J Appl Physiol 74: 1521–1527PubMedCrossRefGoogle Scholar
  32. 32.
    Deitch EA (1990b) Intestinal permeability is increased in burn patients shortly after injury. Surgery 107: 411–416PubMedGoogle Scholar
  33. 33.
    Ziegler TR, Smith RJ, O’Dwyer ST et al. (1988) Increased intestinal permeability associated with infection in burn patients. Arch Surg 123: 1313–1319PubMedCrossRefGoogle Scholar
  34. 34.
    LeVoyer T, Cioffi WG, Pratt L et al. (1992) Alterations in intestinal permeability after thermal injury. Arch Surg 127: 26–30PubMedCrossRefGoogle Scholar
  35. 35.
    Moylan JA (1981) Inhalation injury: a primary determinant of survival following major burns. J Burn Care Rehabil 3: 78–84CrossRefGoogle Scholar
  36. 36.
    Thompson PB, Herndon DN, Traber DL et al. (1986) Effect on mortality of inhalation injury. J Trauma 26: 163–165PubMedCrossRefGoogle Scholar
  37. 37.
    Tredget E, Shankowsky H, Taerum T et al. (1990) The role of inhalation injury in burn trauma. Ann Surg 212: 720PubMedCrossRefGoogle Scholar
  38. 38.
    Youn YK, Lalonde C, Demling R (1992) Oxidants and the pathophysiology of burn and smoke inhalation injury. Free Rad Biol Med 12: 409–415PubMedCrossRefGoogle Scholar
  39. 39.
    Smith DL, Cairns BA, Ramadan F et al. (1994) Effect of inhalation injury, burn size, and age on mortality: a study of 1447 consecutive burn patients. J Trauma 37: 655–659PubMedCrossRefGoogle Scholar
  40. 40.
    Haponik EF, Summer WR (1987) Respiratory complications in burned patients: pathogenesis and spectrum of inhalation injuries. J Crit Care 2: 49–53CrossRefGoogle Scholar
  41. 41.
    Gormsen H, Jeppesen N, Lund A (1984) The causes of death in fire victims. Forensic Sci Int 24: 107–111PubMedCrossRefGoogle Scholar
  42. 42.
    Norris JC, Moore SJ, Hume AS (1986) Synergistic lethality induced by the combination of carbon monoxide and cyanide. Toxicology 40: 121–129PubMedCrossRefGoogle Scholar
  43. 43.
    Hall AH, Rumack BH (1986) Clinical toxicology of cyanide. Ann Emerg Med 15: 1067–1074PubMedCrossRefGoogle Scholar
  44. 44.
    Thom SR (1993a) Leucocytes in carbon monoxide-mediated brain oxidative injury. Toxicol Appl Pharmacol 123: 234–247PubMedCrossRefGoogle Scholar
  45. 45.
    Demling R, Picard L, Campbell C et al. (1993) Relationship of burn-induced lung lipid peroxidation on the degree of injury after smoke inhalation and a body burn. Crit Care Med 21: 1935–1943PubMedCrossRefGoogle Scholar
  46. 46.
    Ischiropoulos H, Mendiguren I, Fisher D et al. (1994b) Role of neutrophils and nitric oxide in lung alveolar injury from smoke inhalation. Am J Respir Crit Care Med 150: 337–341PubMedGoogle Scholar
  47. 47.
    Thom SR, Mendiguren I, Van Winkle T et al. (1994c) Smoke inhalation with a concurrent systemic stress results in lung alveolar injury. Am J Respir Crit Care Med 149: 220–226PubMedGoogle Scholar
  48. 48.
    Herndon DN, Traber DL, Niehaus GD et al. (1984) The pathophysiology of smoke inhalation injury in a sheep model. J Trauma 24: 1044–1051PubMedCrossRefGoogle Scholar
  49. 49.
    Strieter RM, Kunkel SL (1994) Acute lung injury: the role of cytokines in the elicitation of neutrophils. J Clin Invest Med 42: 640–651Google Scholar
  50. 50.
    Moore EE, Moore FA, Franciose RI et al. (1995) The postischaemic gut serves as a priming bed for circulating neutrophils that provoke multiple organ failure. J Trauma 37: 881–887CrossRefGoogle Scholar
  51. 51.
    Koike K, Moore EE, Moore FA et al. (1994) Gut ischaemia/reperfusion produces lung injury independent of endotoxin. Crit Care Med 22: 1438–1443PubMedCrossRefGoogle Scholar
  52. 52.
    Koike K, Moore EE, Moore FA et al. (1995a) Gut phospholipase A2 mediates neutrophil priming and lung injury after mesenteric ischaemia–reperfusion. Am J Physiol 268: 397–403Google Scholar
  53. 53.
    Pitman JM, Anderson BO, Pogetti RS et al. (1991) Platelet activating factor may mediate neutrophil priming following clinical burn and blunt trauma. Surg Forum 15: 108Google Scholar
  54. 54.
    Franciose RJ, Moore EE, Moore FA et al. (1995) Hypoxia/reperfusion of human endothelium activates PMNs to detach endothelial cells in a PAF mechanism. J Surg Res (in press)Google Scholar
  55. 55.
    Koike K, Moore EE, Moore FA et al. (1995b) CD 11b blockade prevents lung injury despite neutrophil priming after gut ischemia/reperfusion. J Trauma 39: 23–27PubMedCrossRefGoogle Scholar
  56. 56.
    Kulling P (1992) Hospital treatment of victims exposed to combustion products. Toxicol Lett 64 /65: 283–289PubMedCrossRefGoogle Scholar
  57. 57.
    Brown SD, Piantadosi CA (1992) Recovery of energy metabolism in rat brain after carbon monoxide hypoxia. J Clin Invest 89: 666–672PubMedCrossRefGoogle Scholar
  58. 58.
    Thom SR, Taber RL, Mendiguren I, et al. (1995) Delayed neuropsychologic sequelae after carbon monoxide poisoning. Prevention by treatment with hyperbaric oxygen. Ann Emerg Med 25: 474–480PubMedCrossRefGoogle Scholar
  59. 59.
    Thom SR (1993b) Functional inhibition of leukocyte B2 integrins by hyperbaric oxygen in carbon monoxide-mediated brain injury in rats. Toxicol Appl Pharmacol 123: 248–256PubMedCrossRefGoogle Scholar
  60. 6o.
    Thom, SR, Mendiguren I, Nebolon M et al. (1994b) Temporary inhibition of human neutrophil B2 integrin function by hyperbaric oxygen. Clin Res 42: 130AGoogle Scholar
  61. 61.
    Yamaguchi KT, Taira MT, Stewart RJ et al. (1990) Thermal and inhalation injury: effect of fluid administration and hyperbaric oxygen. J. Hyperb Med 5: 103–109Google Scholar
  62. 62.
    Stewart RJ, Mason SW, Taira MT et al. (1994) Effect of radical scavengers and hyperbaric oxygen on smoke-induced pulmonary oedema. Undersea Hyperb Med 21: 21–30PubMedGoogle Scholar
  63. 63.
    Thom SR, Mendiguren I, Fisher D (1994a) Parenchymal lung injury following smoke inhalation: inhibition by hyperbaric oxygen. Undersea Biomed Res 78: 55–56Google Scholar
  64. 64.
    Zamboni WA, Roth AC, Russel RC et al. (1993) Morphological analysis of microcirculation during reperfusion of ischaemic skeletal muscle and the effect of hyperbaric oxygen. Plast Reconstr Surg 91: 1110–1123PubMedCrossRefGoogle Scholar
  65. 65.
    Zamboni WA, Stephenson LL, Roth AC et al. (1994) Ischaemia-reperfusion injury in skeletal muscle: CD 18 dependent neutrophil-endothelial adhesion. Undersea Hyperb Med 21 (Suppl): 53Google Scholar
  66. 66.
    Hussmann J, Zamboni WA, Kucan JO et al. (1994a) A model for recording the microcirculatory changes associated with standardised electrical injury of skeletal muscle and its responses towards treatment with hyperbaric oxygen. Undersea Hyperb Med 21 (Suppl): 54Google Scholar
  67. 67.
    Pruit BA Jr (1981) Fluid resuscitation for extensively burned patients. J Trauma 21: 690–692CrossRefGoogle Scholar
  68. 68.
    Korn HN, Wheeler ES, Miller TA (1977) Effect of hyperbaric oxygen on second-degree burn wound healing. Arch Surg 112: 732–737PubMedCrossRefGoogle Scholar
  69. 69.
    Wells CH, Hilton JG (1977) Effects of hyperbaric oxygen on post-burn plasma extravasation. In: Davis JC, Hunt TK (eds) Hyperbaric oxygen therapy. Undersea Medical Society, Bethesda, Maryland, pp 259–265Google Scholar
  70. 70.
    Nylander G, Nordström H, Eriksson E (1984) Effects of hyperbaric oxygen on oedema formation after a scald burn. Burns 10: 193–196CrossRefGoogle Scholar
  71. 71.
    Haapanieni T, Sirsjö A, Nylander G et al. (1995) Hyperbaric oxygen treatment attenuates glutathione depletion and improves metabolic restitution in postischaemic skeletal muscle. Free Rad Res 23: 91–101CrossRefGoogle Scholar
  72. 72.
    Nylander G, Lewis D, Nordström H et al. (1985) Reduction of post-ischaemic edema with hyperbaric oxygen. Plast Reconstr Surg 76: 596–601PubMedCrossRefGoogle Scholar
  73. 73.
    Sirsjö A, Lehr H-A, Nolte D et al. (1993) Hyperbaric oxygen treatment enhances the recovery of blood flow and functional capillary density in postischaemic striated muscle. Circ Shock 40: 9–13PubMedGoogle Scholar
  74. 74.
    Stewart RJ, Yamaguchi KT, Cianci PE et al. (1988) Effects of hyperbaric oxygen on adenosine triphosphate in thermally injured skin. Surg Forum 39: 87–90Google Scholar
  75. 75.
    Kaiser von W, Schnaidt U, Lieth von H (1989) Auswirkungen hyperbaren sauerstoffes auf die frische brandwunde. Handchir Michrochir Plast Chir 21; 158–163Google Scholar
  76. 76.
    Hammarlund C, Svedman C, Svedman P (1991) Hyperbaric oxygen treatment of healthy volunteers with u.v -irradiated blister wounds. Burns 17: 296–301PubMedCrossRefGoogle Scholar
  77. 77.
    Rabkin JM & Hunt TK (1988) Infection and oxygen. In: Davis JC, Hunt TK (eds) Problem wounds: the role of oxygen. Elsevier, Amsterdam, 1: 1–16Google Scholar
  78. 78.
    Deitch EA, Wheelahan TM, Rose MP et al. (1983) Hypertrophic burn scars: an analysis of variables. J Trauma 23: 895–898PubMedCrossRefGoogle Scholar
  79. 79.
    Uhl E, Sirsjö A, Haapaniemi T et al. (1994) Hyperbaric oxygen improves wound healing in normal and ischaemic skin tissue. Plast Reconstr Surg 93: 835–841PubMedCrossRefGoogle Scholar
  80. 80.
    Ketchum SA, Thomas AN, Hall AD (1967) The effects of hyperbaric oxygen on small first, second and third degree burns. Surg Forum 18: 65–67PubMedGoogle Scholar
  81. 81.
    Ketchum SA, Thomas AN, Hall AD (1969) Angiographic studies of the effect of hyperbaric oxygenation on burn wound revascularization. In: Wada J, Iwa T (eds) Hyperbaric medicine. Williams and Wilkins, Baltimore, pp 388–394Google Scholar
  82. 82.
    Arzinger-Jonasch H, Sandner K, Bittner H (1978) Die wirkung hyperbaren sauerstoffs auf brandwunden unterschiedlicher tiefe in tierexperiment. Z Exp Chir Transplant Kunstliche Organe 11: 6–10Google Scholar
  83. 83.
    Hart GB, O’Reilly RR, Broussard ND et al. (1974) Treatment of burns with hyperbaric oxygen. Surg Gynecol Obstet 139: 693–696PubMedGoogle Scholar
  84. 84.
    Grossman AR (1978) Hyperbaric oxygen in the treatment of burns. Ann Plast Surg 1: 163–171PubMedCrossRefGoogle Scholar
  85. 85.
    Niu AKC, Yang C, Lee HC et al. (1987) Burns treated with adjunctive hyperbaric oxygen therapy: a comparative study in humans. J. Hyperb Med 2: 75–86Google Scholar
  86. 86.
    Hanquet M, Lamy M, Castermans (1968) Hyperbaric oxygen complementary to common burn therapy. Proc of the International Burn Symposium, Bochum, Germany, pp 127–136Google Scholar
  87. 87.
    Merola L, Piscatelli F (1978) Considerazioni e prospettive sull’mpiego dell’ossigeno ad aumentata pressione nel trattamento della malattia da ustione. Ann Med Nav 83: 515–526Google Scholar
  88. 88.
    Cianci P, Lueders HW, Lee H et al. (1989) Adjunctive hyperbaric oxygen therapy reduces length of hospitalisation in thermal burns. J Burn Care Rehabil 10: 432–435PubMedCrossRefGoogle Scholar
  89. 89.
    Waisbren BA, Schutz D, Collentine G et al. (1982) Hyperbaric oxygen in severe burns. Burns 8: 176–179CrossRefGoogle Scholar
  90. 9o.
    Cianci P, Lueders HW, Lee H et al. (1988) Adjunctive hyperbaric oxygen reduces the need for surgery in 40–80% burns. J Hyperb Med 3: 97–101Google Scholar
  91. 91.
    Cianci P, Lueders HW, Lee H et al. (1990) Adjunctive hyperbaric oxygen in the treatment of thermal burns–an economic analysis. J Burn Care Rehabil 11: 140–145PubMedCrossRefGoogle Scholar
  92. 92.
    Grossmann AR, Grossmann AJ (1982) Update on hyperbaric oxygen and treatment of burns. Hyperb Oxygen Rev 3: 51–59Google Scholar
  93. 93.
    Kindwall EP, Gottlieb LJ, Larson DL (1991) Hyperbaric oxygen therapy in plastic surgery: a review article. Plast Reconstr Surg 898–908Google Scholar
  94. 94.
    Gorman D, Leitch I (1988) The role of hyperbaric oxygen on thermal burn injuries: a brief review of the literature and the results of a pilot study. SPUMS J 18: 121–123Google Scholar
  95. 95.
    Perrins DJD (1967) Influence of hyperbaric oxygen on the survival of split skin grafts. Lancet 1: 868–871PubMedCrossRefGoogle Scholar
  96. 96.
    Grim PS, Nahum A, Gottlieb L et al. (1989) Lack of measurable oxidative stress during HBO therapy in burn patients. Undersea Biomed Res (Suppl); 16: 22Google Scholar
  97. 97.
    Ray CS, Green B, Cianci P (1989) Hyperbaric oxygen therapy in burn patients with adult respiratory distress syndrome. Undersea Biomed Res (Suppl); 16: 81Google Scholar
  98. 98.
    Feldmeier JJ, Boswell RN, Brown M et al. (1987) The effects of hyperbaric oxygen on the immunologic status of healthy human subjects. In: Bakker D (ed) Proc Eighth International Congress on Hyperbaric Med. Best Publish Company, Flagstaff, Ariz, pp 41–46Google Scholar
  99. 99.
    Hussmann J, Kucan JO, Zamboni WA et al. (1994b) Lymphoid subpopulation changes after acute and chronic treatment with HBO in a 30% scald burn rat model. Undersea Hyperb Med 21 (Suppl): 54–55Google Scholar
  100. 100.
    Hart G, Strauss M, Lennon P, Whitcraft D (1985) Treatment of smoke inhalation by hyperbaric oxygen. J Emerg Med 3: 211–215PubMedCrossRefGoogle Scholar
  101. 101.
    Grube BJ, Marvin JA, Heimbach DM (1988) Therapeutic hyperbaric oxygen: help or hindrance in burn patients with carbon monoxide poisoning? J Burn Care Rehabil 9: 249–252PubMedCrossRefGoogle Scholar
  102. 102.
    Kinsella J, Booth MG (1991) Pain relief in burns: Jaimes Laing memorial essay 1990. Burns 17391–395Google Scholar
  103. 103.
    UHMS (1992b) Carbon monoxide poisoning and smoke inhalation. In: Thom S (ed) Hyperbaric oxygen therapy: a committee report, UHMS publ #30 CR (HBO) 2: 12–17Google Scholar
  104. 104.
    UHMS (1992a) Thermal burns. In: Thom S (ed) Hyperbaric oxygen therapy: a committee report, UHMS pubi #30 CR (HBO), chap 12: 60–64Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • F. Lind
    • 1
  1. 1.Division of Hyperbaric Medicine, Department of Anaesthesiology and Intensive CareKarolinska HospitalStockholmSweden

Personalised recommendations