Delayed treatment for decompression illness: factors associated with long treatment delays and treatment outcome

Sofia A. Sokolowski, Anne K. Räisänen-Sokolowski, Laura J. Tuominen, Richard V. Lundell

    Research output: Contribution to journalArticleScientificpeer-review

    Abstract

    Introduction: Effectiveness of delayed hyperbaric oxygen treatment (HBOT) for decompression illness (DCI) and factors affecting treatment delays have not been studied in large groups of patients. Methods: This retrospective study included 546 DCI patients treated in Finland in the years 1999–2018 and investigated factors associated with recompression delay and outcome. Treatment outcome was defined as fully recovered or presence of residual symptoms on completion of HBOT. The symptoms, use of first aid oxygen, number of recompression treatments needed and characteristics of the study cohort were also addressed. Results: Delayed HBOT (> 48 h) remained effective with final outcomes similar to those treated within 48 h. Cardiopulmonary symptoms were associated with a shorter treatment delay (median 15 h vs 28 h without cardiopulmonary symptoms, P < 0.001), whereas mild sensory symptoms were associated with a longer delay (48 vs 24 h, P < 0.001). A shorter delay was also associated with only one required HBOT treatment (median 24 h vs 34 h for those requiring multiple recompressions) (P = 0.002). Tinnitus and hearing impairment were associated with a higher proportion of incomplete recoveries (78 and 73% respectively, P < 0.001), whereas a smaller proportion of cases with tingling/itching (15%, P = 0.03), nausea (27%, P = 0.03), motor weakness (33%, P = 0.05) and visual disturbances (36%, P = 0.04) exhibited residual symptoms. Patients with severe symptoms had a significantly shorter delay than those with mild symptoms (median 24 h vs 36 h respectively, P < 0.001), and a lower incidence of complete recovery. Conclusions: Delayed HBOT remains an effective and useful intervention. A shorter delay to recompression is associated with fewer recompressions required to achieve recovery or recovery plateau.

    Original languageEnglish
    Pages (from-to)271-276
    Number of pages6
    JournalDIVING AND HYPERBARIC MEDICINE
    Volume52
    Issue number4
    DOIs
    Publication statusPublished - Dec 2022
    Publication typeA1 Journal article-refereed

    Keywords

    • Decompression sickness
    • Epidemiology
    • First aid oxygen
    • Hyperbaric oxygen treatment
    • Remote locations
    • Treatment sequelae

    Publication forum classification

    • Publication forum level 1

    ASJC Scopus subject areas

    • General Medicine

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