Barotrauma is a side scrolling game that takes place in the distant future, on a submarine traversing the inhospitable oceans of Europa, one of Jupiter's moons.

The submarine's crew are given a mission, which may involve hauling cargo from one outpost to another, hunting hostile undersea wildlife, or recovering alien artifacts.

The game has a 2D side-view perspective and features a complex simulation of multiple systems within the submarine, including oxygen levels, power, weapons and the crew's health.

Player incompetence can also be a source of disaster, as improperly-maintained ship equipment (such as nuclear reactors or oxygen generators) can quickly render the submarine inoperable.

Crisis management is a recurrent theme in moment-to-moment gameplay, as players are implicitly encouraged to use their job skills to both avoid and mitigate disaster.

The game provides both single-player and multiplayer modes, which enable players to venture into the vast, unexplored depths of the ocean, taking on various tasks while managing resources, dealing with environmental hazards, and hostile creatures.

The game's core gameplay loop revolves around cooperation among the players to maintain life support systems, repair the submarine, and ward off enemy attacks.

However, he also critiqued Space Station 13's unintuitive user interface and various technical issues; with Barotrauma, Rikkonen sought to create a game that "built on the foundation of SS13" while "smoothing some of the rougher edges".