title: Delayed recompression for decompression sickness: retrospective analysis.
abstract: BACKGROUND
  Most cases of decompression sickness (DCS) occur soon after surfacing, with 98% within 24 hours. Recompression using hyperbaric chamber should be administrated as soon as feasible in order to decrease bubble size and avoid further tissue injury. Unfortunately, there may be a significant time delay from surfacing to recompression. The time beyond which hyperbaric treatment is non effective is unclear. The aims of the study were first to evaluate the effect of delayed hyperbaric treatment, initiated more than 48 h after surfacing for DCS and second, to evaluate the different treatment protocols.
  
  
  METHODS
  From January 2000 to February 2014, 76 divers had delayed hyperbaric treatment (≥48 h) for DCS in the Sagol center for Hyperbaric medicine and Research, Assaf-Harofeh Medical Center, Israel. Data were collected from their medical records and compared to data of 128 patients treated earlier than 48 h after surfacing at the same hyperbaric institute.
  
  
  RESULTS
  There was no significant difference, as to any of the baseline characteristics, between the delayed and early treatment groups. With respect to treatment results, at the delayed treatment divers, complete recovery was achieved in 76% of the divers, partial recovery in 17.1% and no improvement in 6.6%. Similar results were achieved when treatment started early, where 78% of the divers had complete recovery, 15.6% partial recovery and 6.2% no recovery. Delayed hyperbaric treatment using US Navy Table 6 protocol trended toward a better clinical outcome yet not statistically significant (OR=2.786, CI95%[0.896-8.66], p=0.07) compared to standard hyperbaric oxygen therapy of 90 minutes at 2 ATA, irrespective of the symptoms severity at presentation.
  
  
  CONCLUSIONS
  Late recompression for DCS, 48 hours or more after surfacing, has clinical value and when applied can achieve complete recovery in 76% of the divers. It seems that the preferred hyperbaric treatment protocol should be based on US Navy Table 6.
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Hadanny
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Gregori
authors.initials: G
authors.lastname: Fishlev
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Bechor
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Bergan
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Mony
authors.initials: M
authors.lastname: Friedman
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Maliar
authors.affiliation: The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Research and Development Unit, Assaf Harofeh Medical Center, Zerifin, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Shai
authors.initials: S
authors.lastname: Efrati
mesh_terms: D000328:Adult; D003665:Decompression Sickness / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods*; D007557:Israel; D008297:Male; D012189:Retrospective Studies; D061665:Time-to-Treatment; D016896:Treatment Outcome