title: Lower risk of decompression sickness after recommendation of conservative decompression practices in divers with and without vascular right-to-left shunt.
abstract: BACKGROUND
  A vascular right-to-left shunt (r/l shunt) is a well-known risk factor for the development of decompression sickness (DCS). No studies to date have examined whether divers with a history of DCS with or without a r/l shunt have a reduced risk of suffering recurrent DCS when diving more conservative dive profiles (CDP).
  
  
  METHODS
  Twenty-seven divers with a history of DCS recommended previously to dive more conservatively were included in this study and retrospectively interviewed by phone to determine the incidence of DCS recurrence.
  
  
  RESULTS
  Twenty-seven divers performed 17,851 dives before examination in our department and 9,236 after recommendations for conservative diving. Mean follow up was 5.3 years (range 0-11 years). Thirty-eight events of DCS occurred in total, 34 before and four after recommendation of CDP. Four divers had a closure of their patent foramen ovale (PFO). A highly significant reduction of DCS risk was observed after recommendation of CDP for the whole group as well as for the sub-groups with or without a r/l shunt. A significant reduction of DCS risk in respect to r/l shunt size was also observed.
  
  
  CONCLUSIONS
  This study indicates that recommendations to reduce nitrogen load after DCS appear to reduce the risk of developing subsequent DCS. This finding is independent of whether the divers have a r/l shunt or of shunt size. The risk of suffering recurrent DCS after recommendation for CDP is less than or equal to an unselected cohort of divers.
  
  
  CONCLUSIONS
  Recommendation for CDP seems to significantly reduce the risk of recurrent DCS.
authors.affiliation: HNO-Praxis am Odeonsplatz, Brienner Strasse 13, 80333 München, Germany. info@tauchersprechstunde.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Klingmann
authors.forename: Nils
authors.initials: N
authors.lastname: Rathmann
authors.forename: Daniel
authors.initials: D
authors.lastname: Hausmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruckner
authors.forename: Rolf
authors.initials: R
authors.lastname: Kern
mesh_terms: D000328:Adult; D000368:Aged; D003664:Decompression; D003665:Decompression Sickness / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004242:Diving / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006344:Heart Septal Defects, Atrial / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000008:administration & dosage; D012189:Retrospective Studies; D012306:Risk; D012308:Risk Management; D055502:Secondary Prevention
chemical_list: D009584:Nitrogen