HBOT Therapy

HBOT Treatment Protocols

Pressure, Session Length, Course Length

Individualized Care

Why Protocols Vary by Indication

HBOT is not a single treatment. The pressure, session length, daily frequency, and total course length are calibrated to the indication, based on the published evidence and the UHMS Indications Manual. A patient being treated for sudden sensorineural hearing loss receives a different protocol than a patient with a diabetic foot ulcer or delayed radiation cystitis.

Each patient at Evolve receives an individualized treatment plan after a physician-led consultation. The plan is documented in writing and explained to the patient before treatment begins.

General Parameters

Across Indications

  • Treatment pressure
    2.0–2.4 atmospheres absolute (ATA) for the chronic and subacute indications Evolve treats. ISSNHL is typically delivered at 2.4 ATA.
  • Gas breathed
    100% medical-grade oxygen at chamber pressure.
  • Session length
    90 minutes at treatment pressure. Total visit ~2 hours including pressurization and depressurization.
  • Frequency
    Once daily, Monday–Friday, for most outpatient courses. Compromised graft or flap protocols may run twice daily for the first 24–48 hours.
  • Course length
    20–40 sessions for most chronic indications. ISSNHL is typically 20 sessions. Up to 60 sessions for established osteoradionecrosis. Compromised grafts and flaps: 10–20 sessions guided by clinical response.
  • Interim review
    Every 10 sessions for chronic indications, with physician reassessment of progress and protocol adjustment.

Session Structure

A Standard Treatment Session

1

Pre-session check-in

Vitals, brief physician or nursing review, change into provided cotton scrubs.

2

Equalization briefing

Short reminder of ear-clearing technique.

3

Pressurization

Gradual increase from surface pressure to treatment pressure over ~10 minutes.

4

Treatment at pressure

90 minutes at therapeutic pressure breathing 100% oxygen.

5

Depressurization

Gradual decrease to surface pressure over ~10 minutes.

6

Post-session

Brief check, glucose check if indicated, return of belongings.

Sample Protocols

Typical Protocols by Indication

These are typical Evolve protocols, aligned with the UHMS Indications Manual. Individual plans may vary based on clinical assessment.

Sudden sensorineural hearing loss (ISSNHL)

  • Pressure: 2.4 ATA
  • Session length: 90 minutes at pressure
  • Frequency: daily, Monday–Friday
  • Course: 20 sessions, with additional sessions considered based on response
  • Concurrent corticosteroid therapy recommended per ENT pathway
  • Must be started within 14–30 days of symptom onset for best evidence of benefit

Chronic non-healing wounds (incl. diabetic foot ulcers)

  • Pressure: 2.0–2.4 ATA
  • Session length: 90 minutes at pressure
  • Frequency: daily, Monday–Friday
  • Course: 30–40 sessions typical, with interim wound reassessment every 10 sessions
  • Concurrent standard wound care and offloading required

Delayed radiation tissue injury

  • Pressure: 2.0–2.4 ATA
  • Session length: 90 minutes at pressure
  • Frequency: daily, Monday–Friday
  • Course: typically 30–40 sessions, sometimes extending to 60 for bony radiation injury (osteoradionecrosis)

Refractory osteomyelitis

  • Pressure: 2.4 ATA
  • Session length: 90 minutes at pressure
  • Frequency: daily, Monday–Friday
  • Course: 30–40 sessions, alongside antibiotic and surgical management

Compromised skin grafts and flaps

  • Pressure: 2.0–2.4 ATA
  • Session length: 90 minutes at pressure
  • Frequency: often twice daily for the first 24–48 hours, then daily
  • Course: typically 10–20 sessions, guided by clinical response

Protocols for the remaining OHIP-covered indications we treat follow the same structure and are detailed on each condition’s page. Acute emergency hyperbaric protocols (carbon monoxide poisoning, decompression sickness, air embolism, acute crush injury) are not delivered at Evolve and are managed at tertiary acute-care hyperbaric services.

References

  1. Moon RE (ed.). Hyperbaric Oxygen Therapy Indications. 14th edition. North Palm Beach, FL: Best Publishing Company; 2019.
  2. Bennett MH, Kertesz T, Perleth M, Yeung P, Lehm JP. Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database Syst Rev. 2012 Oct 17;10:CD004739.
  3. Stoekenbroek RM, Santema TB, Legemate DA, Ubbink DT, van den Brink A, Koelemay MJ. Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2014 Jun;47(6):647–55.
Medical review

Dr. Vik Agarwal MD CCFP FRCPC CAQ-HP — President, Evolve Medical Group

Dr. Seema Agarwal MD CCFP CAQ-HP — Chief Medical Officer, Evolve Hyperbarics

Last reviewed: May 2026 · Next: May 2027

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