(I) Class I Indications
1. Diseases caused by air bubbles:
1) Decompression sickness
2) Air embolism (diving, iatrogenic, accidental)
2. Poisoning
1) Acute carbon monoxide poisoning
High-risk groups with complications from carbon monoxide poisoning should receive hyperbaric oxygen therapy*
2) Cyanide poisoning
*High-risk groups with complications include:
① Loss of consciousness;
② Accompanied by neurological, cardiovascular, and respiratory symptoms;
③ Pregnant women;
④ HBCO levels measured at any time exceeding 25%;
⑤ Advanced age (over 60 years old) or underlying conditions such as diabetes.
3. Acute Ischemic States
1) Critical Flaps
Not all flaps require hyperbaric oxygen therapy*
Critical flaps are classified into the following 5 categories:
① Locally hypoxic flaps;
② Low arterial perfusion flaps;
③ Arterial occlusion flaps;
④ Venous congestion flaps;
⑤ Venous occlusion flaps.
2) Compartment Syndrome
3) Crush Injuries
4) Postoperative vascularization disorders after limb amputation (finger, toe)
5) Hemorrhagic shock that cannot be resolved by blood transfusion, such as when there is no blood supply or religious restrictions on blood transfusion.
*Hyperbaric oxygen therapy for critical flaps must adhere to the following 5 points:
① Determine if the flap is critical;
② There is evidence of continued perfusion of the flap;
③ Hyperbaric oxygen therapy has a pathophysiological basis;
④ Hyperbaric oxygen therapy should be administered after necessary surgical treatment;
⑤ If hyperbaric oxygen therapy is to be given, it should be started as early as possible.
4. Infectious Diseases
1) Necrotizing soft tissue infections (necrotizing cellulitis, necrotizing fasciitis, necrotizing myositis, etc.)
2) Gas gangrene
3) Refractory osteomyelitis
4) Intracranial abscess
5) Refractory fungal infections
6) Pneumocystis nigra (intestinal wall cysts)
7) Necrotizing otitis externa
5. Radiation-Induced Tissue Injuries
1) Radiation-Induced Osteonecrosis (confirmed and prophylactic)
2) Radiation-Induced Soft Tissue Injuries (confirmed and prophylactic radiation-induced necrosis of the brain, muscles, and other soft tissues)
3) Radiation-Induced Hemorrhagic Cystitis
4) Radiation-Induced Proctitis
5) Preoperative and postoperative prophylactic treatment of radiation-induced mandibular injury in stomatology
6. Wounds
1) Diabetic Infected Ulcers
※Deep (reaching bone or tendons) infected ulcers that are difficult to heal in diabetic patients, with no improvement after one month of wound care;
2) Gangrenous Pyoderma
3) Pressure Ulcers
4) Burns
※Hyperbaric oxygen therapy is recommended for second- and third-degree burns.
5) Chronic venous ulcers
7. Other aspects:
1) Sudden deafness
2) Central retinal artery occlusion
3) Traumatic brain injury
4) Sound-induced or noise-induced deafness
5) Acute central retinal choroiditis
6) Acute fundus blood supply disorder
(II) Class II indications
1. Nervous system:
1) Hypoxic brain injury
2) Acute and chronic cerebral ischemia
3) Stroke recovery period
4) Intellectual disability
5) Meningitis
6) Cerebral edema
7) Acute infectious polyradiculitis
8) Viral encephalitis
9) Multiple sclerosis
10) Spinal cord injury
11) Peripheral nerve injury
12) Autism
13) Chronic encephalopathy of non-vascular factors (such as Alzheimer's disease, Korsakoff syndrome/Wernicke encephalopathy, 14) Cognitive impairment (e.g., Alzheimer's disease)
15) Demyelinating diseases caused by other factors (poisoning, ischemia, etc.), such as delayed encephalopathy due to carbon monoxide poisoning.
Niemann-Pick disease/sphingomyelin storage disease
16) Cognitive impairment (e.g., Alzheimer's disease)
17) Demyelinating diseases caused by other factors (poisoning, ischemia, etc.), such as delayed encephalopathy due to carbon monoxide poisoning. 2. Heart:
1) Acute coronary syndrome
2) Myocardial infarction
3) Cardiogenic shock
3. Vascular system:
1) Chronic peripheral vascular insufficiency
2) Aseptic femoral head necrosis
3) Hepatic artery thrombosis
4. Wounds:
1) Rectovaginal fistula
2) Surgical wound dehiscence
3) Spider bite
4) Frostbite
5) Recurrent oral ulcers
6) Chemical skin damage
7) Post-routine plastic surgery, post-transplantation
5. Poisoning
1) Carbon tetrachloride, hydrogen sulfide, ammonia, pesticide poisoning (hyperbaric oxygen therapy is contraindicated in paraquat poisoning)
2) Toxic encephalopathy
3) Lung injury caused by acute heat, chemical factors, or inhaled smoke
6. Other
1) Altitude sickness
2) Periodontal disease
3) Peptic ulcer
4) Ulcerative colitis
5) Crohn's disease
6) Liver necrosis
7) Sports injuries and rehabilitation
8) Fatigue syndrome
9) Osteoporosis
10) Poor bone healing after fracture
11) Migraine or cluster headache
12) Adjuvant therapy for malignant tumors (in combination with radiotherapy or chemotherapy)
13) Paralytic ileus
14) Tetanus
15) Tinnitus
16) Diabetic retinopathy, glaucoma, post-retinal detachment surgery
17) Before and after pterygium ophthalmic surgery
18) Psoriasis, pityriasis rosea
II. Contraindications
1. Untreated pneumothorax
2. Concurrent use of disulfiram-like drugs
3. Concurrent use of antitumor drugs such as bleomycin, cisplatin, doxorubicin
4. Premature and/or low birth weight newborns
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