Hyperbaric oxygen in the critically ill.

OBJECTIVE To review aspects of hyperbaric medicine pertinent to treating critically ill patients with hyperbaric oxygen in both monoplace and multiplace chambers. DATA SOURCES Literature review of online databases, research repositories, and clinical trial registries. RESULTS The search of these resources produced information regarding technical considerations, feasibility, risk, and patient management. Hyperbaric oxygen is used in treating a number of disorders that occur in critically ill patients, including acute carbon monoxide poisoning, arterial gas embolism, severe decompression sickness, clostridial gas gangrene, necrotizing fasciitis, and acute crush injury. Most chambers in the United States treat outpatients with problem nonhealing wounds, and many chambers are not hospital-based. Only a few hyperbaric medicine centers have intensive care unit-level staffing, specialized equipment, a 24/7 schedule, and experience in treating critically ill patients. Not all intensive care unit-related equipment can be subjected to hyperbaric pressurization, and some equipment may increase the risk for fire inside the chamber. CONCLUSIONS Treating critically ill patients with hyperbaric oxygen requires specialized equipment and personnel with intensive care unit skills and knowledge of the physiology and risks unique to hyperbaric oxygen exposure. Like with all medical interventions, it is important to consider the risk vs. the benefit of hyperbaric oxygen for any given critical care disorder, but hyperbaric oxygen can be delivered safely to critically ill patients. Many critical care environments without present hyperbaric oxygen capability may wish to consider offering hyperbaric oxygen to patients with hyperbaric oxygen-approved indications.