An Introduction to Clinical Aspect of Decompression Illness (DCI) (original) (raw)

IntroductIon D ecompression Illness (DCI) is a complex condition that can appear with a wide variety of signs and symptoms. Any significant organic or functional decrement in individuals who have been exposed to a reduction in environmental pressure must be considered as possibly being DCI until proven otherwise. This applies to acute, sub-acute and chronic changes related to decompression and may be related to acute clinical symptoms or to situations that may develop subclinically and insidiously. It is in fact generally accepted that subclinical forms of DCI, with little or no reported symptoms, may cause changes in the bones, the central nervous system and the lungs (Kelemen, 1983; Shinoda et al., 1997; Wilmshurst and Ross, 1998). Generally, a disorder is a physical derangement, frequently slight and transitory in nature. A disease is considered a condition of an organ, part, structure, or system of the body in which there is abnormal function resulting from genetic predisposition, diet, or environmental factors. A disease is typically a more serious, active, prolonged and deep-rooted condition. DCI should be considered a disorder due to a physical primary cause that can transform into a disease unless adequate and timely action is undertaken to abort or to minimize the pathophysiological effects of bubbles on the body tissues. The predominant physical cause of DCI is the separation of gas in the body's tissues, due to inadequate decompression, leading to an excessive degree of gas supersaturation (Kumar et al., 1990). Rapid decompression (rate of ascent or omission of decompression stops) is a primary cause of gas separation in tissues (Figure 1). The most obvious prevention strategy for DCI is, therefore, determining and observing appropriate ascent and decompression procedures (Marroni and Zannini, 1981; ABSTRACT. Decompression Illness (DCI), Decompression Sickness (DCS), Dysbaric Illness (DI), disorder, syndrome are terms associated with the clinical signs or symptoms originally generated by a reduction of absolute pressure surrounding the patient. For 100 years the definition of the "disease" is a matter of "disputes" or "consensi". We understand nowadays that it is not enough to know how to cure evident clinical manifestations, but also to reduce or virtually eliminate the primary physical cause for the physiological damages: the gas separation phase from saturated tissues-stationary or circulating bubbles. To achieve this goal, research is more oriented on the decompression procedures or the diver pre-conditioning (heat exposure, physical activity, whole body vibration, antioxidant medication, oxygen breathing, hyperbaric oxygen therapy, hydration or dehydration) and post-conditioning (different decompression procedures or models, deep stops, shallow stop followed by a deeper one, post exposure hydration, speed of ascent, exercise during decompression). Some factors that were believed to be crucial, such as patency of the cardiac Foramen Ovale or gender, are considered less important than modified decompression procedures that are studied today with sharper technology.