The treatment of decompression sickness

Area of Science:

• Diving Medicine
• Hyperbaric Physiology
• Neurology

Background:

• Decompression sickness (DCS) originates from gas supersaturation, leading to bubble formation.
• Type 1 DCS (joint pain) responds well to immediate recompression.
• Type 2 DCS presents insidiously, potentially involving blood-brain barrier dysfunction, making pressure less effective than oxygen therapy.

Purpose of the Study:

• To evaluate optimal treatment strategies for decompression sickness (DCS).
• To identify effective therapies for both Type 1 and Type 2 DCS, including gas embolism.
• To propose a unified treatment approach for air and mixed-gas diving incidents.

Main Methods:

• Review of existing therapeutic approaches for DCS.
• Analysis of treatment efficacy based on symptom onset and type.
• Evaluation of recompression strategies using oxygen and helium-oxygen mixtures.

Main Results:

• Recompression is highly effective for immediate Type 1 DCS symptoms.
• High partial pressure of oxygen is more effective than pressure alone for Type 2 DCS.
• A 4 ata recompression with 50% oxygen/50% helium mixture offers a viable compromise for severe DCS and gas embolism in air diving.

Conclusions:

• Standard oxygen therapy can worsen symptoms; air tables may lead to recurrence.
• Helium-oxygen mixtures are recommended for DCS treatment in heliox diving.
• Intravenous fluids and steroids are crucial adjuncts when DCS therapy is delayed.