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Severe Decompression Sickness Associated with Shock and Acute Respiratory Failure
Joint Authors
Arjomand, Abdullah
Holm, James R.
Gerbino, Anthony J.
Source
Issue
Vol. 2020, Issue 2020 (31 Dec. 2020), pp.1-4, 4 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2020-11-05
Country of Publication
Egypt
No. of Pages
4
Main Subjects
Abstract EN
Decompression sickness (DCS) is a well-recognized complication of diving but rarely results in shock or respiratory failure.
We report a case of severe DCS in a diver associated with shock and respiratory failure requiring mechanical ventilation.
A healthy 50-year-old male diver dove to a depth of 218 feet for 43 minutes while breathing air but omitted 6.5 hours of air decompression due to diver error.
The clinical presentation was remarkable for loss of consciousness, hypotension, cutis marmorata, peripheral edema, and severe hypoxia requiring mechanical ventilation with diffuse lung opacities on chest radiograph.
Laboratories were significant for polycythemia and hypoalbuminemia.
A single hyperbaric oxygen treatment was provided on the day of admission during which shock worsened requiring aggressive volume resuscitation and three vasopressors.
In the first 37 hours of hospitalization, 22 liters of crystalloid and multiple albumin boluses were administered for refractory hypotension by which time all vasopressors had been discontinued and blood pressure had normalized.
He required 10 days of mechanical ventilation and was discharged on day 21 with mild DCS-related neurologic deficits.
This clinical course is characteristic of DCS-related shock wherein bubble-endothelial interactions cause a transient capillary leak syndrome associated with plasma extravasation, hemoconcentration, and hypovolemia.
The pathophysiology and typical clinical course of DCS-related shock suggest the need for aggressive but time-limited administration of crystalloid and albumin.
Because hyperbaric oxygen is the primary treatment for DCS, treatment with hyperbaric oxygen should be strongly considered even in the face of extreme critical illness.
American Psychological Association (APA)
Arjomand, Abdullah& Holm, James R.& Gerbino, Anthony J.. 2020. Severe Decompression Sickness Associated with Shock and Acute Respiratory Failure. Case Reports in Critical Care،Vol. 2020, no. 2020, pp.1-4.
https://search.emarefa.net/detail/BIM-1146324
Modern Language Association (MLA)
Arjomand, Abdullah…[et al.]. Severe Decompression Sickness Associated with Shock and Acute Respiratory Failure. Case Reports in Critical Care No. 2020 (2020), pp.1-4.
https://search.emarefa.net/detail/BIM-1146324
American Medical Association (AMA)
Arjomand, Abdullah& Holm, James R.& Gerbino, Anthony J.. Severe Decompression Sickness Associated with Shock and Acute Respiratory Failure. Case Reports in Critical Care. 2020. Vol. 2020, no. 2020, pp.1-4.
https://search.emarefa.net/detail/BIM-1146324
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1146324