A significant and consistently positive body of evidence from animal and human studies of thermal injury supports the use of hyperbaric oxygen as a means of preventing dermal ischemia, reducing edema, modulating the zone of stasis, preventing partial- to full-thickness conversion, preserving cellular metabolism and promoting healing. The vast majority of clinical reports have shown reduction in mortality, length of hospital stay, number of surgeries and cost of care. Hyperbaric oxygen has been demonstrated to be safe in the hands of those thoroughly trained in rendering this therapy in the critical care setting and with appropriate monitoring precautions. Careful patient selection is mandatory.