Treatment of decompression illness and latrogenic gas embolism

The mainstay of treatment of gas bubble disease is therapeutic recompression while the patient is breathing oxygen. The patient should be recompressed as soon as possible; however, patients should be considered for recompression even after several days' delay. Treatments should be repeated if possible until symptoms have either resolved or stabilized. Appropriate hydration is essential. The use of HBO is generally safe, relatively nontoxic, and is possible even in neonates. Pharmacologic agents (e.g., anticoagulants, lidocaine, antiplatelet agents, corticosteroids, inhibitors of calcium flux) may be useful adjuncts to recompression therapy but they require further study. For patients who respond poorly to recompression therapy, the next advance in the treatment of DCI-induced neural injury is likely to be due to the development of agents that reduce the effects of reperfusion injury and delayed cell death.