DELAYED TREATMENT OF DECOMPRESSION SICKNESS TYPE II RESPONSIVE TO HYPERBARIC OXYGEN
Journal
Macedonian Journal of Anaesthesia
Date Issued
2023-10
Author(s)
Etemi, Jildiz
Nacevska Gjorgjeska, Andrijana
Leshi, Albert
Cvetkova Mladenovska, Marija
Abstract
A 38-years-old recreational female diver presented at our hospital with fatigue, dizziness, cutis
marmorata, swollen and painful ankles, back pain and pulmonary symptoms. The patient was
diving in the Maldives, with series of daily dives mostly around 22m, each dive decompression
made on 6m with duration of 3 minutes. After more than 30 hours from her last dive, she took an
international flight Maldives – North Macedonia that lasted for about 12 hours. Her first checkup
was more than 80 hours of the onset of symptoms. Neurological examination, electrocardiogram,
chest X-ray and lung ultrasound were normal. Laboratory data only showed evidence of
thrombocytopenia and elevated D-dimer. Decompression sickness type II was diagnosed
according to history and physical examination. Recompression treatment with hyperbaric oxygen
(HBO2) was immediately started (2.8 ATA on 100% oxygen over a period of 90 minutes) and
additional session at the same day with a duration of 70 minutes to 2.4 ATA. Additional courses
with HBO2 were required daily in the next 7 days to 2.4 ATA. The most of the patient’s symptoms
were resolved after the third therapy with HBO2, and the cough after the 7th therapy. The patient
was released from hospital after resolution of the symptoms. Conclusion: Cutis marmorata is often
associated with more serious manifestations of decompression sickness. Treatment with HBO2 is
the cornerstone therapy for DCS. Indeed, treatment with hyperbaric oxygen can be successful
even in cases with delayed start.
marmorata, swollen and painful ankles, back pain and pulmonary symptoms. The patient was
diving in the Maldives, with series of daily dives mostly around 22m, each dive decompression
made on 6m with duration of 3 minutes. After more than 30 hours from her last dive, she took an
international flight Maldives – North Macedonia that lasted for about 12 hours. Her first checkup
was more than 80 hours of the onset of symptoms. Neurological examination, electrocardiogram,
chest X-ray and lung ultrasound were normal. Laboratory data only showed evidence of
thrombocytopenia and elevated D-dimer. Decompression sickness type II was diagnosed
according to history and physical examination. Recompression treatment with hyperbaric oxygen
(HBO2) was immediately started (2.8 ATA on 100% oxygen over a period of 90 minutes) and
additional session at the same day with a duration of 70 minutes to 2.4 ATA. Additional courses
with HBO2 were required daily in the next 7 days to 2.4 ATA. The most of the patient’s symptoms
were resolved after the third therapy with HBO2, and the cough after the 7th therapy. The patient
was released from hospital after resolution of the symptoms. Conclusion: Cutis marmorata is often
associated with more serious manifestations of decompression sickness. Treatment with HBO2 is
the cornerstone therapy for DCS. Indeed, treatment with hyperbaric oxygen can be successful
even in cases with delayed start.
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