Hyperbaric oxygen therapy (HBOT) has been an established treatment for both diving-related and iatrogenic AGE for many years. Although there are no randomized controlled trials demonstrating the positive effect of HBOT, there are numerous case reports and case series and also sound mechanistic principles that support its use in AGE.

 

The high oxygen tension promotes the resorption of nitrogen from the bubble and the elevated ambient pressure reduces the size of the bubbles in accordance with Boyle’s law. At 282 kPa (a conventional HBOT treatment pressure), spherical gas bubble diameter will be reduced to 82% with a resulting 45% decrease in volume, such that bubble passage through the microcirculation and resolution of embolic phenomena may occur. In their review of 27 case series, Moon and Gorman report substantial improvement in outcome in patients with AGE treated with HBOT.