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Surfactant Depletion Combined with Injurious Ventilation Results in a Reproducible Model of the Acute Respiratory Distress Syndrome ARDS
Published on: April 7, 2021
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Severe Decompression Sickness Associated with Shock and Acute Respiratory Failure
Abdullah Arjomand1, James R Holm2, Anthony J Gerbino2,3,4
1Sections of Graduate Medical Education, Virginia Mason Medical Center, Seattle, WA, USA.
Case Reports in Critical Care
|November 18, 2020
Summary
Severe decompression sickness (DCS) can cause shock and respiratory failure. Aggressive fluid resuscitation and hyperbaric oxygen are crucial, even in critical illness.
Area of Science:
- Emergency Medicine
- Hyperbaric Medicine
- Diving Medicine
Background:
- Decompression sickness (DCS) is a known risk of diving.
- Severe DCS leading to shock and respiratory failure is rare.
Observation:
- A 50-year-old male diver experienced severe DCS after omitting decompression.
- Presentation included shock, respiratory failure, hypoxia, and edema.
- Required mechanical ventilation, aggressive fluid resuscitation, and vasopressors.
Findings:
- DCS-related shock involves capillary leak, plasma extravasation, and hypovolemia.
- Treatment involved significant crystalloid and albumin administration.
- Patient required 10 days of mechanical ventilation and showed mild neurologic deficits.
Implications:
- Aggressive, time-limited fluid and albumin resuscitation is indicated for DCS shock.
- Hyperbaric oxygen therapy should be considered despite critical illness severity.
- Understanding DCS pathophysiology guides management of severe diving accidents.
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