Is Decompression Sickness Self-Limited?
No, decompression sickness is not a self-limited disease and requires definitive treatment with hyperbaric oxygen therapy to prevent permanent disability or death. 1, 2
Why DCS Requires Active Treatment
Decompression sickness occurs when dissolved inert gas forms bubbles in tissues and blood vessels during or after ascent, causing mechanical tissue disruption, vascular occlusion, platelet activation, endothelial dysfunction, and capillary leakage. 3, 2 This pathophysiological cascade does not spontaneously resolve without intervention and can progress to severe complications.
The natural history of untreated DCS demonstrates progression rather than resolution:
- Symptoms typically develop within 24 hours of surfacing and can range from joint pain and fatigue to severe neurological deficits, cardiovascular collapse, and death. 1, 2
- Without treatment, the bubble-induced inflammatory cascade and tissue damage continue to worsen. 2
- Recurrent episodes tend to be more severe than the original incident, indicating cumulative tissue damage rather than self-resolution. 3, 1
Critical Treatment Requirements
Definitive treatment with hyperbaric oxygen is mandatory for all cases of DCS:
- High-flow 100% oxygen should be administered immediately as first aid during transport. 1, 4, 5
- Hyperbaric oxygen therapy (typically at 2.82 atmospheres absolute using U.S. Navy Treatment Table 6) is the definitive treatment and is effective in most cases. 2, 5
- Prompt recompression therapy significantly improves prognosis, while delayed treatment increases the risk of permanent neurological deficits. 1, 2
Severity-Based Outcomes Without Treatment
Mild to moderate DCS presenting with joint pain, fatigue, or rash will not spontaneously resolve and requires immediate hyperbaric oxygen therapy to prevent progression. 1
Severe DCS with neurological symptoms (motor weakness, ataxia, altered mental status) or pulmonary involvement (chest tightness, cough, dyspnea, hypotension) can be fatal without recompression therapy. 3, 1
Arterial gas embolism, which can occur alongside DCS, may present with sudden neurological symptoms, convulsions, or sudden death from coronary embolism—clearly not self-limited. 3, 2
Common Pitfall to Avoid
Do not mistake temporary symptom stabilization for resolution. Even if symptoms appear mild initially, the underlying bubble formation and inflammatory processes continue without treatment, and residual deficits can remain even after delayed treatment. 2, 5 Any suspected DCS requires immediate referral to the nearest hyperbaric chamber. 4