Recompression Treatment

Definition

Recompression treatment is the use of elevated pressure to treat conditions within the body after it has been subjected to a rapid decrease in pressure. It also includes hyperbaric oxygen therapy.

Purpose

Recompression treatment is used to overcome the adverse effects of gas embolism and decompression sickness (sometimes called the bends) in underwater divers who breathe compressed air. It is also approved for treatment of severe smoke inhalation, carbon monoxide poisoning, gas gangrene, radiation tissue damage, thermal burns, extreme blood loss, crush injuries, and wounds that won't heal.

Precautions

Hyperbaric oxygen therapy delivers greater amounts of oxygen more quickly to the body than breathing room air (which is only 21% oxygen) at regular pressure. Unmonitored, increased oxygen can produce toxic effects. Treatments must follow safe time-dose limits and may only be administered by a doctor.

Description

Recompression treatment is performed in a hyperbaric chamber, a sealed compartment in which the patient breathes normal air or "enhanced" air with up to 100% oxygen while exposed to controlled pressures up to three times normal atmospheric pressure. The patient may receive the oxygen through a face mask, a hood or tent around the head, or an endotracheal tube down the windpipe if the patient is already on a ventilator. When used to treat decompression sickness or gas embolism, the increased pressure reduces the size of gas bubbles in the patient's body. The increased oxygen concentration speeds the diffusion of the nitrogen within the bubbles out of the patient's body. As gas bubbles deflate, the trauma of gas embolism and decompression sickness begins to resolve. Treatment for diving emergencies typically involves one session, lasting four to six hours, at three atmospheres of pressure.

When used to treat other conditions, the increased pressure allows oxygen and other gases to dissolve more rapidly into the blood and thus be carried to oxygen-starved tissues to enhance healing. Elevated oxygen levels can also purge toxins such as carbon monoxide from the body. In addition, when body tissues are super-saturated with oxygen, the destruction of some bacteria is enhanced and the spread of certain toxins is halted. This makes hyperbaric oxygen therapy useful in treating gas gangrene and infections that cause tissue necrosis (death). Hyperbaric oxygen therapy also promotes the growth of new blood vessels.

Preparation

Oxygen is often administered to a patient as first aid while he or she is being transported to a hyperbaric chamber. The treatment begins with chamber compression; as the pressure of the chamber atmosphere increases, the temperature also rises and the patient's ears may fill as they would during an airplane landing. Swallowing and yawning are ways to relieve the inner ear pressure. Once the desired pressure is achieved, the patient is given pure oxygen to breathe. Because treatment is lengthy, patients are encouraged to sleep or listen to music. In larger chambers, patients may also read or watch videos.

Aftercare

Depending on the reason for treatment and the treatment outcome, the patient may be taken to a hospital for further care, or examined and released.

Risks

There is minimal risk when recompression treatment is administered by a competent physician. However, some common side effects are sinus pain, temporary changes in vision, and fatigue.

Normal results

With prompt and appropriate recompression treatment, most patients show marked improvement in their blood oxygen levels and tissue circulation, as well as other signs of healing. Divers treated for gas embolism or decompression sickness may recover with no lasting effects.

Abnormal results

When recompression treatment is not begun promptly or not conducted at adequate time-dose levels, patients with decompression sickness may develop bone necrosis. This significant destruction of bone, most commonly found in the hip and shoulder, produces chronic pain and severe disability. Another result of delayed or inadequate treatment may be permanent neurological damage. When decompression sickness involves the spinal cord, partial paralysis may occur.

Resources

ORGANIZATIONS

American College of Hyperbaric Medicine. P.O. Box 25914-130, Houston, Texas 77265. (713) 528-0657. 〈http://www.hyperbaricmedicine.org〉.

Divers Alert Network. The Peter B. Bennett Center, 6 West Colony Place, Durham, NC 27705. (800) 446-2671. 〈http://www.diversalertnetwork.org〉.

Undersea and Hyperbaric Medical Society. 10531 Metropolitan Ave., Kensington, MD 20895. (301) 942-2980. 〈http://www.uhms.org〉.

KEY TERMS

Atmosphere— A measurement of pressure. One atmosphere equals the pressure of air at sea level (14.7 pounds per square inch [psi]).

Compressed air— Air that is held under pressure in a tank to be breathed underwater by divers. A tank of compressed air is part of a diver's scuba (self-contained underwater breathing apparatus) gear.

Decompression— A decrease in pressure from the surrounding water that occurs with decreasing diving depth.

Decompression sickness— A condition found in divers in which gas bubbles of nitrogen form in tissues and blood vessels as a result of decreasing surrounding pressure, such as in ascent from a dive. It may be a painful condition, especially as nitrogen bubbles invade the joints; persons stricken may walk stooped over in pain, in a bent stance that led to it being called "the bends."

Gas embolism— The presence of gas bubbles in the bloodstream that obstruct circulation. Also called air embolism.

Hyperbaric chamber— A sealed compartment in which patients are exposed to controlled pressures up to three times normal atmospheric pressure. Hyperbaric treatment may be used to regulate blood gases, reduce gas bubbles, and provide higher levels of oxygen more quickly.

Recompression— Restoring the elevated pressure of the diving environment to treat decompression sickness and gas embolism by decreasing bubble size.