Key result
Delayed hyperbaric treatment shows similar complete recovery rates to early treatment for decompression sickness.
Why the study?
The time beyond which hyperbaric treatment is non effective for decompression sickness is unclear, especially when treatment is delayed beyond 48 hours after surfacing.
Does delayed hyperbaric treatment (≥48 h) provide similar clinical recovery compared to early treatment (<48 h) in divers with decompression sickness?
Cohort (n=204)
No
Does delayed hyperbaric treatment (≥48 h) provide similar clinical recovery compared to early treatment (<48 h) in divers with decompression sickness?
Absolute Event Rate: 76% vs 78%
p-value: p=0.955
Late recompression for decompression sickness (≥48 hours after surfacing) has clinical value, achieving complete recovery in 76% of divers, similar to early treatment.
May support delayed hyperbaric therapy for decompression sickness when early access is limited; leaves open need for randomized confirmation.
INTRODUCTION: Most cases of decompression sickness (DCS) occur soon after surfacing, with 98% within 24 hours. Recompression using hyperbaric chamber should be administrated as soon as feasible in order to decrease bubble size and avoid further tissue injury. Unfortunately, there may be a significant time delay from surfacing to recompression. The time beyond which hyperbaric treatment is non effective is unclear. The aims of the study were first to evaluate the effect of delayed hyperbaric treatment, initiated more than 48 h after surfacing for DCS and second, to evaluate the different treatment protocols. METHODS: From January 2000 to February 2014, 76 divers had delayed hyperbaric treatment (≥48 h) for DCS in the Sagol center for Hyperbaric medicine and Research, Assaf-Harofeh Medical Center, Israel. Data were collected from their medical records and compared to data of 128 patients treated earlier than 48 h after surfacing at the same hyperbaric institute. RESULTS: There was no significant difference, as to any of the baseline characteristics, between the delayed and early treatment groups. With respect to treatment results, at the delayed treatment divers, complete recovery was achieved in 76% of the divers, partial recovery in 17.1% and no improvement in 6.6%. Similar results were achieved when treatment started early, where 78% of the divers had complete recovery, 15.6% partial recovery and 6.2% no recovery. Delayed hyperbaric treatment using US Navy Table 6 protocol trended toward a better clinical outcome yet not statistically significant (OR=2.786, CI95%[0.896-8.66], p=0.07) compared to standard hyperbaric oxygen therapy of 90 minutes at 2 ATA, irrespective of the symptoms severity at presentation. CONCLUSIONS: Late recompression for DCS, 48 hours or more after surfacing, has clinical value and when applied can achieve complete recovery in 76% of the divers. It seems that the preferred hyperbaric treatment protocol should be based on US Navy Table 6.
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Hadanny et al. (2015) conducted a cohort in Decompression sickness (n=204). Delayed hyperbaric treatment (≥48 hours after surfacing) vs. Early hyperbaric treatment (<48 hours after surfacing) was evaluated on Complete clinical recovery (p=0.955). Delayed hyperbaric treatment for decompression sickness achieved a 76% complete recovery rate, which was not significantly different from the 78% rate observed with early treatment.
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