injuries poisoning
Recompression Therapy
Introduction
Recompression therapy is administration of 100% oxygen for up to several hours in a sealed chamber pressurized to at least 1.9 (usually 1.9 to 3.0) atmospheres, gradually lowered to atmospheric pressure. In divers, this therapy is used primarily for Decompression Sickness , (See also Overview of Diving Injuries .) The goals of recompression therapy in diving injuries may include all of the following: Increasing oxygen solubility and delivery Increasing nitrogen washout Decreasing carbon monoxide concentration Decreasing gas bubble size Reducing tissue ischemia Anti-inflammatory effect For Carbon monoxide poisoning , mechanisms include decreasing the half-life of carboxyhemoglobin, reducing ischemia and oxidative stress, and possibly improving mitochondrial function. Hyperbaric oxygen therapy is a term used when the aim is primarily to give high concentrations of oxygen at increased pressure. It is used to treat decompression sickness and arterial gas embolism, and also used for several disorders unrelated to diving (see table). Because recompression is relatively well tolerated, it should be started if there is any likelihood that it would promote recovery; recompression may help even if started up to several days after surfacing. However, success is lower if started late after symptom onset. Recompression chambers are either multiplace, with space for one or more patients on a gurney and for a medical attendant, or monoplace, with space for only one patient. Although monoplace chambers are less expensive, they have some disadvantages when used for critically ill patients, such as limited access to patients who may require intervention while in the chamber. Information regarding the location of the nearest recompression chamber, the most rapid means of reaching it, and the most appropriate source to consult by telephone should be known by most divers, medical staff members, and rescue and police personnel in popular diving areas. Such information is also available from theDivers Alert Network(919-684-9111) 24 hours a day. TheUndersea and Hyperbaric Medical Societyis another invaluable source of general information about recompression. Physician-to-physician consultation can be obtained throughDuke Dive Medicine(919-684-8111). 