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The game's art style is said to be inspired by Link-Dead, a 2D side-scrolling shooter which had also been in development for a while before being presumed dead. The idea of having Lovecraftian monsters be the main threat in the game most likely inspired the enemies in Barotrauma as well. Several developers have attempted to make an actual game based on this concept, but so far none have been completed.

The lab would be attacked by underwater sea creatures, and it would be up to the player to try to escape the lab. The game would've taken place in the depths of the Atlantic Ocean, inside a research lab. Pressure is a game concept that originated from 4chan's video game board /v/. The horror aspects and underwater setting of the game were inspired by Pressure.

The resource management aspects of the game were inspired by Space Station 13, and may have intentionally given Regalis the idea to make the game two-dimensional rather than 3D. Barotrauma draws inspiration from several different sources. He would later begin working on an entirely new game which deviated greatly from his previous works. After the success of Joonas ('Regalis') Rikkonen's SCP - Containment Breach, he was encouraged to begin pursuing a career in game design and to start his own company, Undertow Games.

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