Recompression therapy and adjunctive drug therapy for decompression illness (the bends) Updated

Decompression illness (DCI) is due to the presence of bubbles in the tissues or blood vessels following the reduction of surrounding pressure (decompression). It is most commonly associated with breathing compressed gas while diving underwater. The effects of DCI may vary from the trivial to life-threatening and treatment is usually administered urgently. Recompression is applied while breathing 100% oxygen or a mixture of oxygen and helium (heliox), based on the reduction in bubble size with pressure and more rapid elimination of nitrogen from the bubbles when breathing nitrogen poor mixtures. Recovery without recompression can be slow and incomplete and DCI is responsible for significant health problems in geographical areas where recompression is unavailable. Recompression with 100% oxygen has become universally accepted as the appropriate therapy despite the lack of high quality clinical evidence of effectiveness. This review found only two randomized trials enrolling a total of 268 patients. One trial compared standard oxygen recompression to helium and oxygen recompression, while the other compared oxygen recompression alone to recompression and an adjunctive non-steroidal anti-inflammatory drug (NSAID). Both trials suggested that these additional interventions may shorten the course of recompression required. For example, the use of an NSAID reduced the median number of recompression sessions required from three to two. We conclude that there is little evidence for using one recompression strategy over another in the treatment of decompression illness and that the addition of an anti-inflammatory drug may shorten the course of recompression required. More research is needed.