Treatment preferences for decompression illness amongst Singapore dive physicians - PubMed (original) (raw)

Treatment preferences for decompression illness amongst Singapore dive physicians

Valerie Huali Tan et al. Diving Hyperb Med. 2017 Jun.

Abstract

Introduction: Owing to the scarcity of randomized controlled trials to guide treatment for decompression illness (DCI), there are many unanswered questions about its management. Apart from reviews and expert opinion, surveys that report practice patterns provide information about useful management strategies. Hence, this study aimed to identify current treatment preferences for DCI amongst diving physicians in Singapore.

Methods: An anonymous web-based questionnaire was sent to known diving physicians in Singapore. The demographics of the respondents were captured. Respondents were asked about their preferred management for five different DCI scenarios.

Results: The response rate was 74% (17 of 23 responses). All respondents chose to recompress patients described in the five scenarios. Regarding the number of recompression sessions, "one additional session after no further improvement in signs and symptoms" was the most common end point of treatment across all the scenarios (47 of 85 responses). Analgesics would be used by five physicians, three would use lidocaine and two steroids as adjuvant therapies.

Conclusions: Apart from the general agreement that recompression is indicated for DCI, there was no strong consensus regarding other aspects of management. This survey reinforces the need for robust RCTs to validate the existing recommendations for DCI treatment.

Keywords: Cerebral arterial gas embolism (CAGE); Decompression sickness; Hyperbaric medicine; Hyperbaric oxygen therapy; Recompression; Survey.

PubMed Disclaimer

Conflict of interest statement

Funding and conflicts of interest: nil

Figures

Figure 1

Hyperbaric treatment preferences of 17 physicians for decompression sickness presenting with joint pain only; A – presenting within 4 h; B – presenting at 48 h

Figure 2

Hyperbaric treatment preferences of 17 physicians for decompression illness; A - cutis marmorata; B – mild sensory symptoms at 48 h; C – cerebral air embolism or paraplegia

Similar articles

• [What is the Best Therapeutic Strategy for Decompression Illness? First Aid Oxygen Inhalation and Hyperbaric Oxygen Therapy].
  Kohshi K, Morimatsu Y, Nishikiori H, Tamaki H, Ishitake T. Kohshi K, et al. J UOEH. 2021;43(2):243-254. doi: 10.7888/juoeh.43.243. J UOEH. 2021. PMID: 34092769 Japanese.
• Increasing prevalence of vestibulo-cochlear decompression illness in Malta - an analysis of hyperbaric treatment data from 1987-2017.
  Azzopardi CP, Caruana J, Matity L, Muscat S, Meintjes WAJ. Azzopardi CP, et al. Diving Hyperb Med. 2019 Sep 30;49(3):161-166. doi: 10.28920/dhm49.3.161-166. Diving Hyperb Med. 2019. PMID: 31523790 Free PMC article.
• Consensus guideline: Pre-hospital management of decompression illness: expert review of key principles and controversies.
  Mitchell SJ, Bennett MH, Bryson P, Butler FK, Doolette DJ, Holm JR, Kot J, Lafère P. Mitchell SJ, et al. Undersea Hyperb Med. 2018 May-Jun;45(3):273-286. Undersea Hyperb Med. 2018. PMID: 30028914
• Recompression and adjunctive therapy for decompression illness.
  Bennett MH, Lehm JP, Mitchell SJ, Wasiak J. Bennett MH, et al. Cochrane Database Syst Rev. 2012 May 16;2012(5):CD005277. doi: 10.1002/14651858.CD005277.pub3. Cochrane Database Syst Rev. 2012. PMID: 22592704 Free PMC article. Review.
• Recompression and adjunctive therapy for decompression illness.
  Bennett MH, Lehm JP, Mitchell SJ, Wasiak J. Bennett MH, et al. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005277. doi: 10.1002/14651858.CD005277.pub2. Cochrane Database Syst Rev. 2007. PMID: 17443579 Updated. Review.

Cited by

• Delayed hyperbaric intervention in life-threatening decompression illness.
  Perez MF, Ongkeko Perez JV, Serrano AR, Andal MP, Aldover MC. Perez MF, et al. Diving Hyperb Med. 2017 Dec;47(4):257-259. doi: 10.28920/dhm47.4.257-259. Diving Hyperb Med. 2017. PMID: 29241237 Free PMC article.

References

1. 1. Chng J, Low CTE, Kang WL. The development of hyperbaric and diving medicine in Singapore . Singapore Med J. 2011;52:901–905. - PubMed
2. 1. Undersea and Hyperbaric Medical Society . Durham NC: UHMS; 2011. [cited 2017 April 14]. UHMS best practice guidelines prevention and treatment of decompression sickness and arterial gas embolism . Available from: https://www.uhms.org/images/DCS-AGE-Committee/dcsandage_prevandmgt_uhms....
3. 1. US Navy Diving Manual . Navsea SS521-AG-PRO-010, Revision 6, August, 2008, Chapter 21 . [cited 2017 April 14]; Available from: https://www.uhms.org/images/DCS-and-AGE-Journal-Watch/recompression_the....
4. 1. Bennett MH, Lehm JP, Mitchell SJ, Wasiak J. Recompression and adjunctive therapy for decompression illness . Cochrane Database Syst Rev. 2012 May;16(5):CD005277. doi: 10.1002/14651858.CD005277.pub3. - DOI - PMC - PubMed
5. 1. Bennett M, Mitchell S, Dominguez A. Adjunctive treatment of decompression illness with a non-steroidal anti-inflammatory drug (tenoxicam) reduces compression requirement . Undersea Hyperb Med. 2003;30:195–205. - PubMed

MeSH terms

Substances

LinkOut - more resources

• Full Text Sources

  • Europe PubMed Central
  • PubMed Central