How long can recompression be delayed?

Decompression sickness is the clinical constellation of symptoms that result from gas bubbles that form after going from a high pressure environment to a lower pressure environment. Classically, it was discovered in caisson workers, but today most of the cases are due to diving. The bubbles are not from the oxygen that is required for the diver to breathe at depth, but from the inert gases mixed with it to prevent oxygen poisoning.

Symptoms can be varied, from muscle and joint pain, to itching, to fatigue, to neurologic deficits and more. Current teaching is to refer all patients with suspected decompression sickness to facilities with hyperbaric treatment facilities as soon as possible. With more and more people flying to distant locales to dive, people are presenting with decompression illness days later. This isn’t necessarily a new phenomenon, as this article is from 1984.

It’s a case series, and only 3 patients at that. They presented to hyperbaric centers at 7, 5, and 3 days after symptoms started, respectively. All had neurological involvement. All also had complete resolution of their symptoms after appropriate treatment, at least until their one year followup.

So is there a consensus on how to treat patients who have delayed presentation? Not that I could find. The authors recommend titrating according to patient response. That isn’t particularly helpful, but all of the patients in this series were treated with US Navy Treatment Table 6. Per the article, there have been successful treatments as far as 10 days out from symptom onset. As always, you can contact the Diver’s Alert Network at +1-919-684-9111 for help with managing your patient.

Myers RA, Bray P. Delayed treatment of serious decompression sickness. Ann Emerg Med. 1985 Mar;14(3):254-7. [PMID 3977150]