Hyperbaric medicine

Hyperbaric medicine is a clinical specialty treating patients with diseases or injuries inside a hyperbaric chamber.

Breathing 100 per cent oxygen under 2-3 bar pressure assists oxygen delivery into infected, injured and ischemic hypoxic tissues. Threatened regions can be rescued and infections eradicated. Hyperbaric oxygen (HBO) also has dose-dependent pharmaceutical effects on inflammation, angiogenesis and wound healing.

HBO therapy is based on good theoretical and experimental evidence, longstanding use, clinical consensus and controlled clinical trials (Stockholm FOCUS report 2011).

Our rectangular 4-lock ICU chamber is staffed and equipped for full intensive care. Technical and clinical developments permit safe treatment strategies of life-threatening emergencies e.g. gas embolism, carbon monoxide poisoning and necrotizing soft tissue infections, also in children. Less critically ill "hypoxic disorders" are treated in monoplace chambers e.g. radiation injuries, refractory healing, brain abscesses and infected implants.

Our main HBO research focus is to proceed with prospective randomized clinical trials and preclinical translational research cooperation internationally to clarify clinical significance, pathophysiology and mechanisms of action. New treatment strategies are of value for the patient, hospital and society. Rare diseases and infectious complications treated with HBO will be evaluated and published as cohort studies e.g. surgical site infections.

Stockholm County Council focus report from 2011 on treatment with hyperbaric oxygen at the Karolinska University Hospital (pdf) 

Group members

Folke Lind MD, PhD, senior consultant hyperbaric medicine
Peter Kronlund

Critical care paramedic, registered nurse, perfusionist hyperbaric medicine

Scientific collaborators

Karl-Åke Jansson MD, PhD, Associate Professor, Chief orthopedic trauma surgery, Karolinska University Hospital
Kerstin Brismar MD, PhD, Professor of diabetes research, Karolinska Institutet
Sergiu Catrina MD, PhD, Karolinska Institutet
Jonas Malmstedt MD, PhD, Karolinska Institutet

Nicklas Oscarsson

MD, Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg
Lotta Renström Koskela MD, PhD, Department of Urology, Karolinska University Hospital
Enrique Castellanos MD, PhD, Uro- and gastro-oncology, Radiumhemmet, Karolinska University Hospital
Ann-Cathrin Hellström MD, PhD, Associate Professor, Gynecological Oncology, Radiumhemmet, Karolinska University Hospital
Daniel Danielsson DDS, Department of Maxillofacial Surgery, Karolinska University Hospital
Anna Norrby-Teglund MD, PhD, Professor, Center for Infectious Medicine, Karolinska Institutet, and Karolinska University Hospital
Britt Nordlander MD, PhD, Associate Professor, Department of Otorhinolaryngology, Karolinska University Hospital
Tiit Mathiesen MD, PhD, Professor, Department of Neurosurgery, Karolinska University Hospital
Bengt Gustavsson MD, Department of Neurosurgery, Karolinska University Hospital
Göran Lind MD, PhD, Department of Neurosurgery, Karolinska University Hospital

Gaston Schechtmann

MD, PhD, Department of Neurosurgery, Karolinska University Hospital
Helena Saraste MD, PhD, Associate Professor, Department of Orthopedic Surgery, Karolinska University Hospital, and Karolinska Institutet
Pär-Johan Svensson MD, pediatric surgeon, Astrid Lindgren Children's Hospital, Karolinska University Hospital, and Karolinska Institutet
Ulf Andersson MD, PhD, Professor, senior physician in pediatric rheumatology, head of pediatric unit at the Dept of women's and children's health, Karolinska University Hospital


1. Clinical trials

Hyperbaric Oxygen in Lower Limb Trauma (HOLLT)

An international multi-centre randomized clinical trial to assess the benefit of twelve HBO treatments in acute trauma management of severe lower leg open fractures and crush injuries. Primary/secondary endpoints include early (two-week) and late (two-year) infection and complication rates by blinded assessor. Folke Lind is European coordinator.

About the study on clinicaltrials.gov

Postoperative Hyperbaric Oxygen Treatments to Reduce Complications in Diabetic patients Undergoing Vascular Surgery (HODiVA)

Karolinska double-blind single-centre randomized clinical trial to assess the benefit of nine HBO treatments in diabetics after peripheral vascular surgery. Primary/secondary endpoints are time to complete healing of operative wounds/infection and complication rates, blood and tissue sampling, etc.

About the study on clinicaltrials.gov

Radiation Induced Cystitis Treated With Hyperbaric Oxygen - A Randomized Controlled Trial (RICH-ART)

Scandinavian multi-centre randomized clinical trial to assess the benefit of forty HBO treatments in patients with late radiation cystitis. Primary/secondary endpoints are relief of symptoms/cystoscopy, clinical and blinded microscopic evaluation of biopsies after six months (with or without HBO). Control group cross-over to HBO five-year follow up.

About the study on clinicaltrials.gov

Hyperbaric Oxygen Treatment of Mandibular Osteoradionecrosis. A Randomized Clinical Study (DAHANCA-21)

Scandinavian multi-centre randomized clinical trial assessing thirty pre- and ten postsurgery HBO treatments in head and neck cancer patients with late radiation injury of the mandible (ORN). Primary/secondary endpoints are one-year ORN status/QL, BMI, pain intensity, trismus, xerostomia and dysphagia.

About the study on clinicaltrials.gov

Improving Outcome of Necrotizing Fasciitis: Elucidation of Complex Host and Pathogen Signatures that Dictate Severity of Tissue Infection (INFECT)

European five-year EU FP7 HEALTH financed translational research programme on necrotizing soft tissue infections with fourteen partners coordinated by Professor Anna Norrby-Teglund, Karolinska Institutet. Folke Lind is team leader for the Karolinska University Hospital, one of five clinical partners responsible for 1) patient enrolment in clinical registry 2) collection of bacterial isolates, blood and tissue samples 3) continued development and implementation of guidelines for classification and management of necrotizing soft tissue infections and 4) clinical validation of new diagnostic tests.

2. Cohort studies

Long-term follow-up of consecutive patients (including children) with rare diseases, infections and complications to neurosurgery or trauma treated with HBO.

3. Preclinical research

HBO mechanisms.

4. Clinical development

HBO equipment, standards and procedures.

Research support

  • European Commission (INFECT; EU FP7 HEALTH)
  • Stockholm County Council
  • AFL medicine project (HIF as potential target for treatment of diabetic wounds)


Hyperbaric critical care patient data management system.
Kronlund P, Lind F, Olsson D
Diving Hyperb Med 2012 Jun;42(2):85-7

Hyperbaric oxygen treatment of postoperative neurosurgical infections.
Larsson A, Engström M, Uusijärvi J, Kihlström L, Lind F, Mathiesen T
Neurosurgery 2008 Feb;62 Suppl 2():652-71

Impact of acute hypobaric hypoxia on blood flow distribution in brain.
Pagani M, Salmaso D, Sidiras G, Jonsson C, Jacobsson H, Larsson S, et al
Acta Physiol (Oxf) 2011 Jun;202(2):203-9

Necrotizing fasciitis following transobturator tape treated by extensive surgery and hyperbaric oxygen.
Flam F, Boijsen M, Lind F
Int Urogynecol J Pelvic Floor Dysfunct 2009 Jan;20(1):113-5

Hyperbaric oxygen treatment of postoperative neurosurgical infections.
Larsson A, Engström M, Uusijärvi J, Kihlström L, Lind F, Mathiesen T
Neurosurgery 2008 Feb;62 Suppl 2():652-71

Hyperbaric oxygen treatment of active cluster headache: a double-blind placebo-controlled cross-over study.
Nilsson Remahl A, Ansjön R, Lind F, Waldenlind E
Cephalalgia 2002 Nov;22(9):730-9

Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long-term follow-up.
Kalani M, Jörneskog G, Naderi N, Lind F, Brismar K
J. Diabetes Complicat. ;16(2):153-8 

Hyperbaric oxygen therapy for wound complications after surgery in the irradiated head and neck: a review of the literature and a report of 15 consecutive patients.
Neovius E, Lind M, Lind F
Head Neck 1997 Jul;19(4):315-22

Dose-dependent hyperbaric oxygen stimulation of human fibroblast proliferation.
Brismar K, Lind F, Kratz G
Wound Repair Regen ;5(2):147-50

Contact us

Senior researcher

Folke Lind

E-mail: folke.lind@ki.se