Therapeutic management of severe spinal cord decompression sickness in a hyperbaric center

Frontiers in Medicine

Medicine

Jean Morin¹  Emmanuel Gempp¹  Benjamin Simonnet¹  Henri Lehot¹  Arnaud Druelle¹  Romain Roffi¹  Lucille Daubresse¹  Pierre Louge¹  Jean-Eric Blatteau¹  Sébastien de Maistre¹  Nicolas Vallee² 

[1] Department of Diving and Hyperbaric Medicine, Sainte-Anne Military Hospital, Toulon, France;Military Institute of Biomedical Research (IRBA), Subaquatic Operational Research Team (ERRSO), Toulon, France;

关键词: diving;    decompression sickness;    bubbles;    spinal cord;    neurological sequelae;    hyperbaric oxygen therapy;    helium;    lidocaine;   

DOI  :  10.3389/fmed.2023.1172646

 received in 2023-02-24, accepted in 2023-08-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionSpinal cord decompression sickness (scDCS) unfortunately has a high rate of long-term sequelae. The purpose of this study was to determine the best therapeutic management in a hyperbaric center and, in particular, the influence of hyperbaric treatment performed according to tables at 4 atm (Comex 30) or 2.8 atm abs (USNT5 or T6 equivalent).MethodsThis was a retrospective study that included scDCS with objective sensory or motor deficit affecting the limbs and/or sphincter impairment seen at a single hyperbaric center from 2010 to 2020. Information on dive, time to recompression, and in-hospital management (hyperbaric and medical treatments such as lidocaine) were analyzed as predictor variables, as well as initial clinical severity and clinical deterioration in the first 24 h after initial recompression. The primary endpoint was the presence or absence of sequelae at discharge as assessed by the modified Japanese Orthopaedic Association score.Results102 divers (52 ± 16 years, 20 female) were included. In multivariate analysis, high initial clinical severity, deterioration in the first 24 h, and recompression tables at 4 atm versus 2.8 atm abs for both initial and additional recompression were associated with incomplete neurological recovery. Analysis of covariance comparing the effect of initial tables at 2.8 versus 4 atm abs as a function of initial clinical severity showed a significantly lower level of sequelae with tables at 2.8 atm. In studying correlations between exposure times to maximum or cumulative O2 dose and the degree of sequelae, the optimal initial treatment appears to be a balance between administration of a high partial pressure of O2 (2.8 atm) and a limited exposure duration that does not result in pulmonary oxygen toxicity. Further analysis suggests that additional tables in the first 24–48 h at 2.8 atm abs with a Heliox mixture may be beneficial, while the use of lidocaine does not appear to be relevant.ConclusionOur study shows that the risk of sequelae is related not only to initial severity but also to clinical deterioration in the first 24 h, suggesting the activation of biological cascades that can be mitigated by well-adapted initial and complementary hyperbaric treatment.

【 授权许可】

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Copyright © 2023 Simonnet, Roffi, Lehot, Morin, Druelle, Daubresse, Louge, Maistre, Gempp, Vallee and Blatteau.