Decompression illness - Lancet review

Decompression illness is caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure (decompression).

Types of decompression illness

The term decompression illness covers 2 entities:

- arterial gas embolism, in which alveolar gas or venous gas emboli (via cardiac shunts or via pulmonary vessels) are introduced into the arterial circulation

- decompression sickness, which is caused by in-situ bubble formation from dissolved inert gas

Both syndromes can occur in divers, compressed air workers, aviators, and astronauts, but arterial gas embolism also arises from iatrogenic causes unrelated to decompression.

Risk of decompression illness is affected by immersion, exercise, and heat or cold.

Clinical features of decompression illness

Manifestations of this condition include a wide range of symptoms and signs:

- itching and minor pain

- neurological symptoms

- cardiac collapse

- death

Treatment of decompression illness

First-aid treatment is 100% oxygen. Definitive treatment is recompression to increased pressure, breathing 100% oxygen.

Adjunctive treatments include fluid administration and prophylaxis against venous thromboembolism in paralysed patients.

Prognosis of decompression illness

Treatment is effective in most cases although residual deficits can remain in serious cases, even after several recompressions.

References:
Decompression illness. The Lancet, Volume 377, Issue 9760, Pages 153 - 164, 8 January 2011.
Image source: OpenClipArt.org, public domain.