All About Hyperbaric Medicine - Your Complete Guide!

What is hyperbaric medicine?

Hyperbaric medicine is an accredited form of medical treatment, internationally recognized and practiced in specialized centers around the world. Treatment takes place in a hyperbaric chamber, where air pressure is increased in a controlled manner above normal atmospheric pressure. Under these conditions, the patient breathes pure (100%) oxygen, usually through a mask.

The main effect is a significant increase in the amount of oxygen carried by the blood, up to 20 times the usual level. This allows oxygen to also reach areas with reduced or impaired circulation, where healing processes stagnate due to lack of it. Due to the increased pressure, the lungs capture oxygen much more efficiently, and the high concentration in the blood can contribute to the recovery of damaged tissues, depending on the medical indication and the individual response of the patient.

Hyperbaric therapy has proven effective for several acute medical conditions and is used as an adjunctive treatment in many other clinical situations. The list of recognized indications continues to expand based on research and recommendations periodically issued by the European Committee for Hyperbaric Medicine (ECHM) and the US Food and Drug Administration (FDA).

An important moment for the whole field was the award Nobel Prize for Medicine in 2019, for research into how cells detect and respond to changes in oxygen levels. This recognition has generated a new wave of interest and development in hyperbaric medicine, reinforcing decades of clinical experience in the field.

At the Hyperbarium clinic, hyperbaric medicine is practiced under the coordination of physicians certified in this field. The team is led by medical director Dr. Sturz Ciprian, who has over 15 years of experience at leading German clinics, including Klinikum Nürnberg and Klinikum Roth. Treatments follow strict safety protocols and take place in a state-of-the-art, 16-seat hyperbaric chamber—one of the largest and most modern in Romania.

How hyperbaric therapy works

The air we breathe contains approximately 21% oxygen. When we inhale, this oxygen enters the lungs, where it is taken up by red blood cells, also called erythrocytes. These cells contain hemoglobin, a substance that binds to oxygen and transports it through the bloodstream throughout the body. Blood circulates through veins and arteries, delivering oxygen to all the body's tissues and organs. In the tissues, oxygen is released from the red blood cells and enters the cells that need it. This continuous, vital process ensures that every part of the body functions properly. The image below illustrates how oxygen from the air is absorbed and distributed to cells throughout the body.

When blood vessels narrow because of disease, they can no longer deliver enough oxygen to the tissues. This can cause swelling, pain and even cell death, especially in chronic or severe conditions. Hyperbaric therapy addresses this problem by supplying pure oxygen in a chamber pressurized to as much as 3 ATA, allowing more oxygen to reach affected areas even when blood vessels are narrowed. Oxygen can therefore support tissue healing and help prevent cell death caused by oxygen deprivation. The image below illustrates this sequence, from the narrowing of blood vessels to tissue damage caused by insufficient oxygen.

When we breathe pure oxygen (100% oxygen) in a hyperbaric chamber pressurized to as much as 3 ATA, it penetrates the body's tissues much more easily. Even when a blood vessel is obstructed, hyperbaric oxygen can travel up to three times farther than under normal conditions. Areas that were not receiving enough oxygen can therefore become better oxygenated and function more effectively. Symptoms such as swelling and pain, which often occur when tissues receive too little oxygen, may be alleviated by hyperbaric therapy. The treatment also stimulates the formation of new small blood vessels, improving circulation and tissue oxygenation. The image below shows how hyperbaric oxygen reaches much deeper into the tissues through plasma and intercellular fluid, even in the presence of a vascular blockage.

An article published in the American Journal of Physiology in November 2006 examined in detail how hyperbaric therapy supports tissue repair. The researchers found that a type of blood cell known as CD34+ plays an essential role in this process. The number of these bone-marrow-derived cells doubles after only two hours of hyperbaric therapy. After 20 treatments, their number in the bloodstream increases eightfold.

The image below shows how pure oxygen (100%), administered in a specially pressurized hyperbaric chamber, is driven into the tissues by diffusion and promotes the formation of new blood vessels:

To effectively treat medical conditions, hyperbaric oxygen therapy is part of a complex treatment plan, customized according to the patient's therapeutic needs and pre-existing conditions. This plan may also include other therapies or treatment regimens designed to fit each patient's unique needs.

What are the benefits of hyperbaric therapy?

Lack of oxygen to the tissues is the main reason why some wounds do not heal. And hyperbaric oxygen therapy treats this cause. When oxygen reaches the affected areas again, in sufficient and constant concentrations, a series of biological processes that had stagnated can be resumed. This is precisely why hyperbaric therapy is effective in very different clinical situations, which share the same basic mechanism: tissue hypoxia.

Benefits documented in the medical literature and recognized in international guidelines include:

Chronic and ischemic wound healing. Diabetic ulcers, ischemic wounds, or chronic injuries unresponsive to standard treatments may benefit from the additional oxygenation provided by hyperbaric therapy. Oxygen helps restore granulation tissue and can support the healing process where other methods have failed.

Detoxification in carbon monoxide poisoning. It is one of the classic indications and with the most solid clinical foundation. Hyperbaric therapy accelerates the removal of carbon monoxide from the body and may reduce the risk of late neurological complications.

Treatment of severe infections selected. In certain anaerobic bacterial infections, including gas gangrene, or in chronic refractory osteomyelitis, increased oxygen concentrations have a direct effect on the pathogen and potentiate the action of antibiotics.

Reducing the side effects of radiotherapy. Radiotherapy can affect tissue vasculature, leaving areas poorly oxygenated and difficult to heal. Hyperbaric therapy can help restore these tissues, including in the case of osteoradionecrosis, a severe complication that usually responds poorly to treatment.

Mobilization of stem cells. A study published in American Journal of Physiology—Heart and Circulatory Physiology (Thom et al., 2006) showed that a course of 20 HBOT sessions can increase the number of circulating CD34+ stem cells eightfold from baseline. These cells, released from the bone marrow by stimulating nitric oxide synthesis, play an essential role in tissue repair and vascular regeneration.

Stimulation of angiogenesis. Repeated exposure to hyperbaric oxygen can stimulate the formation of new blood vessels in ischemic tissues, improving long-term local circulation. This effect is especially relevant in peripheral vascular diseases and in recovery after severe tissue damage.

Systemic anti-inflammatory effect. Hyperbaric oxygen therapy reduces systemic inflammation by modulating proinflammatory cytokines and the immune response. This mechanism is relevant in conditions with a chronic inflammatory component and can contribute to post-surgical or post-traumatic recovery.

Post-stroke recovery and neuroprotection. Studies published in BMJ Open and Frontiers in Neurology show that hyperbaric therapy may improve cognitive functions such as memory, attention and executive function in patients in the chronic phase after a stroke or traumatic brain injury, by stimulating neuroplasticity and increasing cerebral perfusion.

Recovery from post-Covid syndrome. A randomized, double-blind study published in Scientific Reports (2022) demonstrated that 40 sessions of HBOT significantly improved global cognitive function, sleep quality, energy level, and psychiatric symptoms in patients with persistent post-COVID symptoms. The effects were correlated with neuroplastic changes visible on brain MRI.

These are just some of the benefits of hyperbaric therapy. The full list is much larger and is constantly evolving. If you want to know more about all the benefits and conditions treated, visit the following sections:

It is important to say that these benefits do not occur automatically and are not guaranteed for every patient. The response to treatment depends on the diagnosis, the stage of the disease, the general condition and how the therapy is integrated into the therapeutic plan. At Hyperbarium, the indication is established individually, after a complete medical evaluation, precisely to ensure that the treatment is justified and that the goals pursued are realistic.

What are the conditions treated by hyperbaric medicine?

Hyperbaric medicine is approved to treat a wide range of conditions. The FDA has approved this therapy for 14 different conditions, while the European Committee on Hyperbaric Medicine (ECHM) has already recognized its benefits in over 30 conditions. There are also hundreds of clinical trials, both completed and ongoing, that support the use of this therapy.

The European Hyperbaric Medicine Committee classifies the conditions for which it recommends hyperbaric medicine into several categories:

For a complete overview of the indications, visit the following sections:

• Acute indications
• Chronic indications
• Sports Medicine

There are hundreds of studies completed in the field of hyperbaric medicine, and the doctors at Hyperbarium have categorized these studies for easy access and consultation. If you are interested in exploring them in detail, access the section of scientific studies of the Hyperbarium site.

How is a hyperbaric therapy session conducted at Hyperbarium?

For the mechanism described above to work correctly, the environment in which treatment takes place is essential: the hyperbaric chamber. Not every oxygen capsule meets the same medical standards. Before reviewing the steps of a session, it is therefore useful to understand what a certified hyperbaric chamber looks like and which standards the chamber at Hyperbarium meets.

How safe is hyperbaric therapy?

Information provided by the FDA, along with numerous scientific studies, shows that when hyperbaric therapy is administered correctly in accredited medical centers, it can be considered one of the safest medical treatments available.

Under European and international hyperbaric medicine standards, multiplace chambers are equipped with pneumatically activated fire-suppression systems to protect patients and medical staff. They also have two patient access routes and an airlock that serves as an emergency entrance for medical personnel.

In multiplace hyperbaric chambers, oxygen is administered through an individual mask while the chamber is pressurized. It is important to note that, in multiplace chambers, treatment is not delivered directly under oxygen pressure, and any increase in oxygen concentration inside the hyperbaric chamber is carefully monitored by the operators, who follow specific safety procedures.

The team of doctors specializing in hyperbaric medicine at the Hyperbarium clinic, led by Dr. Sturz Ciprian, urges anyone considering hyperbaric therapy to choose the chamber carefully and pay particular attention to the following three critical factors for a safe and effective experience:

• Make sure the hyperbaric chamber is medically accredited and operated by certified personnel in accordance with applicable regulations.
• Make sure the chamber pressure can reach 3 ATA. (ATA pressure comprises atmospheric pressure of 1 bar plus the additional pressure generated inside the hyperbaric chamber.)
• Make sure the oxygen inhaled during therapy has a purity greater than 99.5%.

At the Hyperbarium clinic, hyperbaric therapy is carried out at the highest standards, offering optimal conditions of comfort and safety. Strict operational protocols, which include initial medical evaluations and constant medical monitoring in the room, are crucial to further enhance patient safety.

Medical HBOT vs mHBOT wellness — why they cannot be compared directly

Not all so-called "hyperbaric chamber" devices are the same. The key difference between HBOT (Medical Hyperbaric Oxygen Therapy) and mHBOT (mild hyperbaric oxygen therapy, used in the wellness context) looks at working pressure, oxygen purity and the indications for which each can be used.

Medical HBOT chambers operate at pressures and oxygen concentrations that allow medically recognized conditions to be treated. mHBOT wellness capsules do not reach those parameters and are not indicated for treating disease. The key differences are summarized below:

European regulations explicitly prohibit the promotion of mHBOT chambers as a medical treatment. In practice, however, some salons and clinics continue to present these capsules as therapeutic alternatives, creating real confusion for patients who have no reason to suspect the difference, as long as both devices are generically called "hyperbaric chamber".

To protect themselves, any patient should ask three simple questions before booking a session:

• Is the chamber certified as a medical device?
• What maximum pressure can it reach?
• What is the purity of the oxygen used during therapy?

Choosing the wrong device for a real diagnosis can waste time, resources and delay proper treatment. The consequences can be more serious than a simple lack of results: for example, a diabetic wound not properly treated in an mHBOT not only does not receive the oxygenation necessary for healing, but may continue to worsen during the period when the patient mistakenly believes that he is receiving appropriate treatment.

The hyperbaric chamber in the Hyperbarium clinic fully complies with the criteria in the table above: it is certified as a Class IIB medical device, operates at pressures up to 3 ATA, with medical oxygen of purity over 99.95%, and is operated exclusively by certified medical personnel. These features place it in the category of medical HBOT, not wellness devices, which is why patients can use the above list of questions as a direct check point for our clinic as well.

How much does a hyperbaric therapy session cost?

Now that you know the main differences between HBOT and mHBOT chambers, you can make an informed decision based on your needs. If you simply want to relax in an oxygen-enriched environment, an mHBOT wellness session may be suitable. But if you are recovering from a serious condition such as a stroke, a hard-to-heal wound such as diabetic foot, or the side effects of radiotherapy, medical hyperbaric therapy is the appropriate option.

The price difference between the two therapies is not very large, especially since the mHBOT sessions are much shorter. In the case of serious conditions, for which recovery can take a long time, the benefits of treatment are usually much greater than the difference in cost.

The price of a hyperbaric therapy session in medical HBOT chambers

In Romania, a therapy session in a medical HBOT chamber usually costs between €80 and €140. In countries with well-developed healthcare systems, such as Austria, Germany, France or Italy, a session often costs more than €300 and may reach €600 at some clinics.

The price of a hyperbaric therapy session at the Hyperbarium Clinic

At the Hyperbarium Oradea clinic, a single session in the hyperbaric chamber costs €100, while the price drops to €80 per session for a package of at least 20 sessions.

Specialist consultation

^€ 50

• Multidisciplinary evaluation, medical specialist control

Individual session

^€ 100

• 1-3h oxygen therapy, continuous 360° monitoring, medical supervision

Package of 20 sessions

^€ 80 /session

• The same standards of medical monitoring and supervision

The 20-session package reduces the cost per session by 20%, an option especially relevant for patients whose treatment protocols require a large number of sessions for optimal results. And the number of sessions is always determined together with the specialist doctor at the initial consultation, not chosen randomly by the patient.

This price reflects the quality of the services as well as the equipment. HBOT chambers, certified by Class IIB according to CEE 93/42, work with pure medical oxygen (>99.5%) and can reach a working pressure of up to 3 ATA. They have a rigid shell and can accommodate between 1 and 30 people. In Romania, HBOT rooms require accreditation from ANMDM and from the health authorities. Operation of an HBOT chamber is permitted only in the presence of qualified medical personnel and periodically certified operators.

The price of a therapy session in mHBOT wellness chambers

For comparison, an mHBOT wellness session in Romania usually costs between €36 and €60 and lasts 60–90 minutes. The lower price does not represent an equivalent, lower-cost medical alternative; it reflects the difference in standards explained in the previous subsection.

Why it's worth evaluating cost by indication, not just budget

Choosing a cheaper session, but inappropriate for the condition being treated, can generate higher indirect costs: repeated sessions without result or the delay of an effective treatment. Therefore, the relevant question for the patient is not only "how much does it cost", but "does this price meet the standards required for my condition?". Hyperbarium Clinic clarifies and argues this answer right from the first visit.

Is hyperbaric therapy reimbursed by CAS?

No. Hyperbaric therapy is not currently reimbursed by Romania's National Health Insurance House, so most patients bear the full cost even when treatment is recommended by a specialist.

This situation does not reflect the lack of medical recognition of the therapy, but an administrative gap compared to other states. In the United States, hyperbaric therapy is used for several recognized medical indications, including decompression sickness, carbon monoxide poisoning, gas embolism, gas gangrene, crush injuries, certain hard-to-heal wounds, including some diabetic ulcers, acute thermal burns, and refractory osteomyelitis. Sudden sensorineural hearing loss and avascular necrosis are also included among the indications recognized by UHMS.

At European level, the European Committee for Hyperbaric Medicine (ECHM) recognizes approximately 30 therapeutic indications, classified into three levels of recommendation. These are the same indications listed in the comparative table in the previous section, and the list is periodically revised as new clinical evidence emerges. In countries such as Germany, France and Italy, treatment for many of these conditions is reimbursed by the state.

For Romanian patients, the fact that the therapy is medically recognized in Europe but is not reimbursed by the state means that each patient must decide with their doctor whether treatment is worthwhile in their case. This is why the initial consultation described above remains essential: it determines not only whether therapy is indicated, but also how many sessions are realistically needed—information that directly affects the patient's planned budget.

What should you expect after a hyperbaric therapy session?

Towards the end of a hyperbaric therapy session, the medical staff will gradually reduce the pressure inside the chamber to allow your body to adjust to the outside pressure. You will be helped to remove the mask and directed to exit the room. Vital signs will then be checked, including blood pressure and pulse, and diabetics will have their blood glucose checked. Once the doctor determines that all parameters are within normal conditions and monitoring is no longer necessary, you can change into street clothes and leave.

Some patients may feel slightly tired or hungrier after the session. But, these sensations are usually temporary. In the absence of special recommendations from the medical team, normal daily activities can be resumed.

What are the results of hyperbaric therapy?

The effectiveness of hyperbaric oxygen therapy can vary depending on the condition in question and the individual patient's condition. The doctor can evaluate the probability of success of hyperbaric therapy based on different factors including the type and severity of the condition being treated, the patient's medical history and the results of existing clinical studies and research. Doctors generally consider:

• Scientific evidence: If there are clinical trials or research supporting the effectiveness of hyperbaric therapy for a particular condition.
• General condition of the patient: The patient's general health, including any other conditions they may have and how these may affect response to therapy.
• Response to previous treatments: How the patient has responded to other treatments for the same condition.

Based on this assessment, the physician can provide an informed estimate of the likelihood of success of hyperbaric therapy in the patient's specific case.

What are the risks and contraindications?

Hyperbaric therapy is considered a safe and reliable treatment, with very little risk of complications. Side effects are generally minor, especially when the duration of treatment does not exceed 3 hours and the pressure inside the chamber is kept below 3 ATA.

The most common side effect of hyperbaric therapy is barotrauma, a condition that manifests as discomfort or pain in the ear. This occurs when there is a pressure difference between each part of the eardrum, similar to the sensation felt during takeoff of an airplane. Other contraindications for hyperbaric therapy include:

• Pneumothorax: The presence of air or gas in the pleural cavity, which can be aggravated by the increased pressure in the hyperbaric chamber.
• Some lung conditions: Severe lung disease, such as emphysema with large bubbles, can increase the risk of lung collapse under pressure.
• Pheochromocytoma: A tumor of the adrenal gland that can secrete hormones uncontrollably under pressure.
• Medication-related considerations: Some drugs, such as doxorubicin (a chemotherapy agent) and cisplatin, can interact adversely with oxygen administered under high pressure.
• History of seizures: Patients with a history of seizures, especially uncontrolled seizures, may be at increased risk of seizures during hyperbaric therapy.
• Pregnancy: Although not an absolute contraindication, the use of hyperbaric therapy during pregnancy requires caution and careful medical evaluation.
• Severe claustrophobia: Because the therapy requires sitting in a closed room, people with severe claustrophobia may have difficulty.
• Middle ear implants: Certain types of middle ear implants can be affected by the pressure in the hyperbaric chamber.

It is important that anyone considering hyperbaric therapy treatment speak with a medical professional to assess the risks and benefits in the context of their condition and individual medical history. The team of specialist doctors from the Hyperbarium clinic is at your disposal for consultation and assessment. Schedule a consultation to discuss the possibilities and benefits of therapy hyperbaric adapted to your needs.

Why choose the Hyperbarium clinic?

The Hyperbarium Clinic is one of the most advanced and modern hyperbaric medicine centers in Romania. Located in Oradea, near the Băile Felix resort, it offers patients a variety of recovery therapies for a wide range of acute and chronic conditions. The clinic covers more than 3,000 square meters and provides state-of-the-art treatment in a modern setting.

The entire staff is trained and certified according to European standards, and the team doctors have skills in hyperbaric medicine. The medical director of the clinic is Dr. Ciprian Sturz, a surgeon specializing in general surgery, visceral and emergency surgery. Dr. Ciprian Sturz returned to his hometown to get involved in this project after more than 15 years of experience in some of the most prestigious hospitals in Germany.

• The entire staff of the clinic is trained and certified at European level, by the German hyperbaric chamber manufacturer, ensuring the highest standards of therapy.
• The clinic's doctors are qualified in hyperbaric medicine in accordance with Order of the Minister of Health no. 418/2005 and consistently apply treatment protocols aligned with the recommendations of the European Committee for Hyperbaric Medicine (ECHM).
• The integrated telemedicine system enables hyperbaric treatment to be monitored simultaneously by specialists at international medical centers of excellence.

Watch the video below with the virtual tour of the Hyperbarium clinic to convince yourself of its professionalism, as well as its modern facilities.

If you are convinced of the quality of our services, we invite you to make an appointment.

FAQ

1. How do I know if hyperbaric therapy is indicated for my condition?

The indication cannot be established solely on the basis of diagnosis or information found online. During the initial consultation, the doctor with skills in hyperbaric medicine evaluates the diagnosis, the stage of the condition, the treatments followed to date, the associated diseases and the realistic goals of the therapy. In some cases, further tests or investigations may be required. Hyperbaric therapy is recommended only when there is a justified medical indication and can be safely integrated into the overall treatment plan.

2. How many sessions are needed?

The number of sessions differs depending on the condition, severity and the patient's response to treatment. The exact protocol is established together with the doctor, after the initial consultation.

3. How often are the sessions held?

The exact pace is set by the doctor specializing in hyperbaric therapy depending on the diagnosis: emergencies may require closer sessions, while the treatment of chronic conditions is planned over several weeks. Adherence to the recommended frequency is important, because the desired effects accumulate during the entire series of treatment.

4. After how many sessions do the results appear?

The time at which the results appear differs from one patient to another. In some acute conditions, the effects can be observed after the first sessions. In chronic wounds, necrosis, post-radiotherapy lesions or neurological recovery, changes usually occur gradually and should be assessed over a complete series. Progress is not only assessed by how the patient feels, but also by clinical examination, measurement of wounds, tests, imaging investigations or other criteria relevant to the diagnosis.

5. What medical documents do I need to bring?

It is useful to bring medical letters, recent test results, relevant investigations and the list of treatments followed. The more complete the information, the more accurate the assessment.

6. Do I need to stop certain medications?

Do not stop drug treatment without the doctor's consent. Some treatments may require adjustments or additional monitoring depending on your medical history, but this is a decision you will discuss with your doctor during your assessment.

7. Can I come for treatment if I have a cold or blocked sinuses?

Notify the clinic before your appointment if you have a stuffy nose, earache, sinusitis, fever, cough or other respiratory symptoms. Congestion can prevent equalization of pressure in the ears and sinuses, increasing the risk of pain or barotrauma. The doctor will decide whether the session can be carried out safely or should be postponed until the symptoms disappear. Do not take decongestant medication just so you can enter the room without first talking to the medical team.

8. Can I do the therapy if I have diabetes?

Yes, diabetes does not exclude hyperbaric therapy, and certain diabetic complications are among its medical indications. However, the treatment requires close monitoring, as the blood sugar can change and decrease during the session. Blood sugar is checked before the session, and the medical team takes into account the treatment followed.

9. Can I do the therapy if I have heart or lung disease?

It depends on the type and severity of the condition. Some heart or lung diseases may require additional caution or may represent contraindications, therefore medical evaluation is necessary before treatment. It is important to mention any recent episodes of chest pain, shortness of breath, pneumothorax, lung intervention or worsening of the disease. You can read more about hyperbaric therapy and heart disease here: https://hyperbarium.com/en/blog/heart-disease-recovery

10. What objects are prohibited in the hyperbaric chamber?

Electronic items, lighters, flammable materials, oily cosmetics or other items that may affect safety are not allowed. As a rule, patients are asked to wear cotton clothes and follow the instructions of the medical team.

11. What do I do if I have claustrophobia?

Tell your doctor at your initial consultation if you have claustrophobia or have had panic attacks in closed spaces. The hyperbaric chamber at the Hyperbarium clinic is one of the largest available on the market, being much more spacious than an individual capsule. This allows the presence of several patients and permanent communication with the medical staff. Depending on the intensity of your symptoms, the team can explain the session in detail and determine if the treatment is tolerable and safe. Do not take sedatives before the session without the doctor's approval, as they can affect the state of consciousness and monitoring.

11. Can I drive and return to normal activities after the session?

Most patients can immediately resume their normal activities and drive after the session is over. Occasionally, mild fatigue, hunger, or subtle changes in vision may occur for a short time. These are usually temporary. If you notice such conditions, inform the medical team and wait until you feel completely well before leaving or driving.