I agree that your in-chamber TCOM should guide you. If tissue TCOM does not exceed 200 mm Hg, tissue healing is unlikely. With other conditions, such as ORN, well researched protocols should be followed unless cotraindicated.
My understanding is that air breaks are not necessary at 2.0 ATA, but I do air breaks if at any risk, the most common being narcotic pain meds. Anything higher, I use air breaks.
What I don't understand is why we use 2.4 ATA as opposed to 2.5. 2.5 ATA = 45 fsw, nice round number. 2.4 ATA = 42.6 fsw. I can't imagine a difference of 2.4 fsw making a significant physiologic difference in either treatment response or risk profile. Why don't we just use 2.5?