[Clinical aspects, pathophysiology and therapy of decompression sickness]

The primary treatment of decompression illnesses (arterial gas embolism and all types of decompression sickness) is recompression therapy, combined with hyperbaric oxygen breathing. It is essential to initiate treatment as soon as the symptoms arise. However, prior to hyperbaric oxygen therapy--particularly with any delay in starting recompression--specific supportive therapy for severe decompression-related injuries is mandatory after first-aid treatment has been given. The preferred supportive treatment would be 100% normobaric oxygen breathing, oral or better i.v. fluids (crystalloids or dextrose saline), flat position on the back, and organization of appropriate means of transportation to the nearest hyperbaric center. Large doses of corticosteroids as well as anticoagulants are under discussion, but there is some evidence that steroids and medium doses of acetylsalicylic acid, given initially, may be of certain benefit for patients suffering from cerebral- and spinal-cord trauma due to decompression accidents. There is evidence that latency of onset of decompression illnesses is a prognostic indicator. Nevertheless, urgent HBO therapy in a hyperbaric chamber suitable for intensive care under pressure is mandatory for all severe decompression disorders.