Recompression treatment for decompression illness: 5-year report (2003-2007) from National Centre for Hyperbaric Medicine in Poland.

A serious diving accident can occur in recreational diving even in countries where diving is not very popular due to the fact that diving conditions there are not as great as in some tropical diving locations. The estimated number of injured divers who need recompression treatment in European hyperbaric facilities varies between 10 and 100 per year depending on the number of divers in the population, number of dives performed annually, and number of hyperbaric centres in the country. In 5 years of retrospective observation in Poland (2003-2007) there were 51 cases of injured recreational divers recorded. They either dived locally or after returning home by air from a tropical diving resort. All of them were treated with recompression treatment in the National Centre for Hyperbaric Medicine in Gdynia which has capability to treat any patient with decompression illness using all currently available recompression schedules with any breathing mixtures including oxygen, nitrox, heliox or trimix. The time interval between surfacing and first occurrence of symptoms was significantly lower in the group of patients with neurological decompression sickness or arterial gas embolism (median 0.2 hours) than in the group of patients with other types of decompression sickness (median 2.0 hours). In both groups, there were different types of recompression tables used for initial treatment and different number of additional sessions of hyperbaric oxygenation (HBO) prescribed, but the final outcome was similar. Complete resolution of symptoms after initial recompression treatment was observed in 24 cases, and this number was increased to 37 cases after additional HBO sessions (from 1 to 20). In the final outcome, some residual symptoms were observed in 12 cases. In 2 cases initial diagnosis of decompression sickness type I was rejected after initial recompression treatment and careful re-evaluation of diving profiles, risk factors and reported symptoms.

[Pneumothorax during hyperbaric oxygenation]. / Odma oplucnowa w trakcie leczenia hiperbarycznego.

BACKGROUND: Tension pneumothorax is an absolute contraindication to hyperbaric oxygenation (HBO). During the decompression, at the end of the hyperbaric session, the increase in gas volume related to decreasing the pressure in the chamber can induce tension pneumothorax. The risk can be minimised, when pleural cavities have been drained before the session. CASE REPORT: A 13-year-old girl was admitted to the Hyperbaric Intensive Therapy Unit after carbon monoxide poisoning and subsequent drowning in a bath and cardiac arrest. She was resuscitated at the site of the accident and transferred to the hyperbaric centre. On admission, she was deeply unconscious, hypothermic, her GCS was 3, and her pupils were non-reacting and maximally dilated. COHb concentration was 48.7%, and X-ray revealed pulmonary oedema. She arrested again and HBO was started during CPR. After 30 min, spontaneous circulation returned and her COHb concentration decreased to 25.6%. During the next 6 h, COHb decreased to 6.5%. The patient developed severe ARDS, and HBO sessions were continued. During the fourth session, the HBO team became aware of an earlier chest x-ray showing a left-sided tension pneumothorax. Emergency decompression was attempted, but it resulted in rapid enlargement of the pneumothorax and deterioration in the patient's condition. The pressure in the chamber was immediately increased and a thoracic drain inserted by the attending anaesthesiologist. Further decompression was uneventful.Despite intensive treatment, the girl died after 85 h of treatment because of severe ARDS. DISCUSSION: Despite initial successful resuscitation, the girl died, primarily due to severe ARDS that was probably related to the near-drowning and repeated CPR. In such cases it is essential to be able to react quickly inside the chamber and an attending anaesthesiologist should be always present in the chamber during HBO sessions.

Pneumoperitoneum after diving--two clinical cases and literature review.

Pneumoperitoneum after diving is a rare symptom. Diagnosis and treatment strongly depends on the primary source of the air in the abdominal cavity. There are two main sources of air entering the perineum: perforation of the gastrointestinal tract and pulmonary barotrauma. The management is different and additionally, in both cases, the decompression sickness and arterial gas embolism as consequences of inappropriate decompression phase of the diving should be included in the clinical diagnosis and treatment. The multidisciplinary team including hyperbaric physicians and surgeons is necessary for proper management of such cases. In this paper two cases of pneumoperitoneum of different origins are presented and similar cases reported in the literature are discussed.