The natural progression of decompression illness and development of recompression procedures

The initial observations in the 19th century of DCS in compressed air workers and divers revealed a disease that could cause severe neurological injury and death, but would often surprisingly resolve spontaneously. The standard of care for this illness today includes recompression with oxygen. For diving injuries occurring in scuba divers or air crew there are presently no convincing data indicating the superiority of any table compared with USN Table 6 or its equivalent. Recompression is a highly effective treatment in most cases if applied shortly after the onset of symptoms. Therefore there is (fortunately) opportunity to monitor the natural course of this illness. However, in keeping with the 19th century experience, it is frequently observed that, when severe instances of DCI do not respond to recompression therapy, the prognosis several weeks or months later is often good. Unlike traumatic spinal cord injury, in which improvements are usually small, the cord is often tolerant to injury of similar severity due to gas bubbles. The obvious combinations of treatment pressure, time and breathing gas composition have been examined, at least anecdotally. Further advances in the treatment of decompression illness are unlikely to occur through new table development, but rather mechanisms by which more prompt recompression can be administered and new adjunctive resuscitative measures.

Duke Scholars

Author Richard Edward Moon Anesthesiology, General, Vascular, High Risk Transplant & Cr ...