Treatment of Decompression Syndrome
Decompression illness requires immediate hyperbaric oxygen therapy as the cornerstone of treatment, with recompression administered as soon as possible regardless of delay from symptom onset. 1, 2
Immediate Recognition and Initial Management
Early Recognition is Critical
- Recognize symptoms rapidly: 98.9% of cases develop initial symptoms within 6 hours after surfacing, with a median latency of 62 minutes 2
- Shorter latent time correlates with more severe symptoms and worse outcomes 2
- Common presentations include cutaneous abnormalities, joint and muscular pain, and neurological manifestations 2
First-Line Emergency Treatment
- Administer high-flow oxygen immediately upon recognition of decompression illness 3
- Establish IV access and begin crystalloid hydration to support circulation 1
- Maintain hemodynamic stability with fluid resuscitation 1
Definitive Treatment: Hyperbaric Oxygen Therapy
Recompression Protocol
- Refer immediately to the nearest hyperbaric chamber for recompression therapy - this is the definitive treatment 3, 2
- Do not delay recompression regardless of time elapsed since symptom onset 2
- Recompression schedules demonstrate 99.3% overall effectiveness when properly administered 2
- Critical timing principle: Full recovery rate decreases significantly with increased delay from symptom onset to treatment 2
Treatment Intensity
- Patients with neurological symptoms require multiple treatments in 23.8% of cases (10 of 42 patients with neurological sequelae) 4
- Most patients (90.5% of those with neurological symptoms) can be adequately treated with up to three hyperbaric sessions 4
Post-Treatment Monitoring
Observation Requirements
- Observe patients for at least 6 hours after initial hyperbaric treatment if neurological symptoms were present 4
- Symptom relapse occurs in up to 38.5% of cases, with half occurring within the first 24 hours 4
- Consider short-term observation unit admission for patients with neurological manifestations to monitor for relapse 4
Critical Pitfalls to Avoid
Never Delay Treatment
- Do not abandon recompression therapy regardless of delay from symptom onset - late treatment still provides benefit 2
- The longer the delay to treatment, the lower the full recovery rate, but partial recovery remains possible 2
Recognize Severity Early
- Shorter latency from decompression to symptoms indicates more serious disease requiring aggressive treatment 2
- Mortality can occur before recompression (9 deaths occurred pre-treatment in a large series) 2