Decompression sickness—an alarming and potentially fatal disorder that novice scuba divers are cautioned about during the very early stages of scuba instruction. Yet, it is an illness that most physicians have not personally treated in the clinical setting because it is only seen in certain circumstances, such as in deep sea diving. Its most serious effects include seizures and paralysis, but the illness can involve any bodily system and may cause a range of symptoms.
Causes and symptoms
Decompression sickness occurs when exposure to atmospheric pressure changes produce alterations of the gases in the body. The prevalence of this condition is monitored and documented in the military setting, and it can affect both professional and recreational divers. Individuals who work in some underwater settings or in certain types of aircraft are also at risk
The illness develops due to rapid movement from a high pressure to a lower pressure environment, which allows the gas bubbles to form within the body. The gas bubbles in the body cause the symptoms, and the symptoms depend on the location of the bubbles, which can form and/or travel anywhere in the body. The most commonly documented symptoms range from musculoskeletal pain, caused by gas bubbles in the joints, to dizziness, weakness, or paralysis, caused by gas bubbles in the brain or spinal cord.
Symptoms may develop during or immediately following the pressure changes or may begin within a few hours after the environmental exposure, although they can take up to 24 hours to develop.
Hyperbaric oxygen treatment
The recommended treatment is hyperbaric oxygen therapy, which is delivered in a hyperbaric chamber by a trained professional using a treatment protocol. This environment places the patient is a high-pressure environment, which reduces the gas bubbles.
Hyperbaric oxygen is also used to treat several other conditions, including carbon monoxide poisoning, and has been considered a potential adjunct in some types of wound care. Overall, it is considered safe: serious adverse events, such as seizures and ear barotrauma, are believed to be reduced by strict adherence to therapeutic protocols.
Hyperbaric oxygen in other neurological conditions
Hyperbaric oxygen therapy has been studied in other neurological disorders, such as multiple sclerosis, peripheral neuropathy and head trauma. Thus far, there is no compelling evidence that hyperbaric oxygen is useful in MS. However, it may show some promise in peripheral neuropathy. There are some clinical studies of small numbers of patients with reported results suggesting that hyperbaric oxygen treatment could improve some of the symptoms and possibly even some objective measures in peripheral neuropathy as well as head trauma.
Have you ever sent a patient for treatment with hyperbaric oxygen? For which medical condition did you prescribe hyperbaric oxygen?