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Minerva Anestesiologica 2009 March;75(3):151-61

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Guiding principles in choosing a therapeutic table for DCI hyperbaric therapy

Antonelli C. ¹, Franchi F ², Della Marta M. E. ³, Carinci A. ⁴, Sbrana G. ², Tanasi P. ¹, De Fina L. ¹, Brauzzi M. ¹

¹ Unit of Diving and Hyperbaric Medicine, Misericordia Hospital, Grosseto, Italy; ² Postgraduate School of Anesthesiology and Intensive Care, University of Siena, Siena, Italy; ³ Unit of Orthopedics and Traumatology, Hospital of Stradella, Pavia General Hospital, Pavia, Italy; ⁴ Unit of Acceptance and Urgency Medicine and Surgery, Hospital of Atessa, Lanciano-Vasto General Hospital, Lanciano, Chieti, Italy

Hyperbaric therapy is the basis of treatment for pervasive development disorders. For this reason, the choice of the right therapeutic table for each case is critical. Above all, the delay in recompression time with respect to the first symptoms and to the severity of the case must be considered. In our experience, the use of low-pressure oxygen tables resolves almost all cases if recompression takes place within a short time. When recompression is possible almost immediately, the mechanical effect of reduction on bubble volume due to pressure is of remarkable importance. In these cases, high-pressure tables can be considered. These tables can also be used in severe spinal-cord decompression sickness. The preferred breathing mixture is still disputed. Heliox seems to be favored because it causes fewer problems during the recompression of divers, and above all, because nitrox can cause narcosis and contributes nitrogen. Saturation treatment should be avoided or at least used only in special cases. In cases of arterial gas embolism cerebral injury, it is recommended to start with an initial 6 ATA recompression only if the time between symptom onset and the beginning of recompression is less than a few hours.