Hyperbaric oxygen therapy: oxygen and bubbles.

Recompression using oxygen is the accepted treatment for decompression injury. As early as 1877 Paul Bert stated that recompression using oxygen is the optimal treatment for decompression problems (2). He also pointed out that this treatment was very effective for getting rid of the gas from the vascular system but much less effective against paralysis and the serious types of decompression sickness. A list of some of the treatments that are used presently is shown in Table 1. They vary quite significantly both in pressure and in oxygen content, going from 190 kPa (9 msw,30 fsw) on air to 780 kPa (68 msw, 204 fsw) using nitrox. Treatments to depth of relief or saturation tables are also used. Even if there is considerable clinical experience with other procedures than the standard US Navy Table 6 (280 kPa using oxygen), there is really little published data to support use of the other treatments. However, it is probably true that the available evidence suggests that treatment at depths shallower than 60 feet runs the risk of failure and that treatments deeper than 60 feet offers no particular benefit in the majority of cases (23).