Surviving Sepsis Campaign guidelines for a diver with DCI: case report

Area of Science:

• Diving Medicine
• Critical Care Medicine
• Hyperbaric Medicine

Background:

• Severe decompression illness (DCI) can cause central nervous system damage and multiple organ dysfunction syndrome (MODS), presenting a significant clinical challenge.
• Standard treatment for DCI involves hyperbaric oxygen (HBO2) therapy according to established protocols, such as the U.S. Navy Treatment Tables.

Observation:

• A case of severe DCI with profound shock and MODS is presented following initial HBO2 therapy using U.S. Navy Treatment Table 6A.
• The patient received low-dose hydrocortisone, a treatment not recommended by the U.S. Navy Diving Manual, in conjunction with subsequent HBO2 treatments.

Findings:

• The administration of low-dose hydrocortisone, alongside HBO2 therapy, led to dramatic clinical improvement in a patient with severe DCI and MODS.
• This therapeutic approach deviated from standard guidelines but resulted in successful patient recovery and discharge.

Implications:

• This case suggests a potential benefit of adjunctive low-dose hydrocortisone in managing severe DCI complicated by MODS, warranting further investigation.
• The findings challenge existing treatment paradigms and highlight the need for exploring novel therapeutic strategies in complex diving-related emergencies.