Pathophysiology of Decompression Illness
Decompression Illness is a gas bubble disease that may occur in association with compressed gas diving. Under certain circumstances bubbles may also develop within the body at high altitudes (e.g., loss of cabin pressure at altitudes > 18,000 ft or in space during extra-vehicular activities). Gas bubbles may also enter the circulation iatrogenically e.g., during cardiac bypass surgery, open heart surgery and several other surgical procedures, or as a result of pulmonary barotrauma. This presentation, however, focuses on gas bubble disease associated with compressed gas diving.
Because the manifestations can range from subtle to severe, the diagnosis may potentially be overlooked or, alternatively, overdiagnosed. As such, the spectrum of target organ damage is used as a framework to establish an optimal index of suspicion as well as a broader pathophysiological perspective from which to choose and rationalise recompression and adjunctive medical treatments.
This presentation represents our current understanding of decompression illness pathophysiology and the clinical manifestations we observe. It addresses the various therapeutic strategies that have appeared over the years, and their limitations.