Delayed treatment of bubble related illness in diving--review of standard protocol

The basic treatment of diver with bubble related illness consists of recompression in medical hyperbaric facility. However transportation of injured diver to hyperbaric chamber can last for several hours. During that time the process induced by gas bubbles spread out and finally result in activation of many pathophysiological events. Currently approved standard of treatment before starting of recompression consists of normobaric oxygenation, intravenous or oral fluids and general stabilization of the patient condition. Usage of several pharmacological agents is promising, including corticosteroids, antiplatelet and anticoagulant therapy or lidocaine. Those drugs are most often used in some centres but still there is lack of randomized controlled studies concerning their efficacy in decompression illness of divers. The review of available bibliography presented in this paper leads to conclusion that recommendations of the Second European Consensus Conference on Hyperbaric Medicine "The Treatment of Decompression Accidents in Recreational Diving" published in 1996 in Marseille, France for fluid replacement and drug therapy for decompression accidents are still valid. This protocol includes the fluid treatment, normobaric oxygen and intensive therapy. Other drugs (aspirin, lidocaine, heparin, steroids, calcium channel blockers, antioxidants) should still be treated as an option considered by clinician, but without strong evidences from clinical studies.