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High-Altitude Decompression Sickness Treated with Hyperbaric Therapy and Extracorporeal Oxygenation.
Aerosp Med Hum Perform. 2020 Feb 01; 91(2):106-109.AM

Abstract

BACKGROUND:

High-altitude decompression sickness (HADCS) is a rare condition that has been associated with aircraft accidents. To the best of our knowledge, the present paper is the first case report of a patient treated for severe HADCS using recompression therapy and veno-venous extracorporeal oxygenation (VV-ECMO) with a complete recovery.

CASE REPORT:

After depressurization of a cabin, the 51-yr-old jet pilot was admitted to the Military Institute of Medicine with a life-threatening HADCS approximately 6 h after landing from a high-altitude flight, in a dynamically deteriorating condition, with progressing dyspnea and edema, reporting increasing limb paresthesia, fluctuating consciousness, and right-sided paresis. Hyperbaric oxygen therapy in the intensive care mode was initiated. A therapeutic recompression with U.S. Navy Treatment Table 6 was performed with neurological improvement. Due to cardiovascular collapse, sedation, mechanical ventilation, and significant doses of catecholamines were started, followed by continuous veno-venous hemodialysis. In the face of disturbances in oxygenation, during the second day of treatment the patient was commenced on veno-venous extracorporeal oxygenation. Over the next 6 d, the patient's condition slowly improved. On day 7, VV-ECMO was discontinued. On day 19, the patient was discharged with no neurological deficits.

DISCUSSION:

We observed two distinct stages during the acute phase of the disease. During the first stage, signs of hypoperfusion, neurological symptoms, and marbled skin were observed. During the second stage, multiple organ dysfunction dominated, including heart failure, pulmonary edema, acute kidney injury, and fluid overload, all of which can be attributed to extensive endothelial damage.Siewiera J, Szałański P, Tomaszewski D, Kot J. High-altitude decompression sickness treated with hyperbaric therapy and extracorporeal oxygenation. Aerosp Med Hum Perform. 2020; 91(2):106-109.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31980050

Citation

Siewiera, Jacek, et al. "High-Altitude Decompression Sickness Treated With Hyperbaric Therapy and Extracorporeal Oxygenation." Aerospace Medicine and Human Performance, vol. 91, no. 2, 2020, pp. 106-109.
Siewiera J, Szałański P, Tomaszewski D, et al. High-Altitude Decompression Sickness Treated with Hyperbaric Therapy and Extracorporeal Oxygenation. Aerosp Med Hum Perform. 2020;91(2):106-109.
Siewiera, J., Szałański, P., Tomaszewski, D., & Kot, J. (2020). High-Altitude Decompression Sickness Treated with Hyperbaric Therapy and Extracorporeal Oxygenation. Aerospace Medicine and Human Performance, 91(2), 106-109. https://doi.org/10.3357/AMHP.5457.2020
Siewiera J, et al. High-Altitude Decompression Sickness Treated With Hyperbaric Therapy and Extracorporeal Oxygenation. Aerosp Med Hum Perform. 2020 Feb 1;91(2):106-109. PubMed PMID: 31980050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-Altitude Decompression Sickness Treated with Hyperbaric Therapy and Extracorporeal Oxygenation. AU - Siewiera,Jacek, AU - Szałański,Przemysław, AU - Tomaszewski,Dariusz, AU - Kot,Jacek, PY - 2020/1/26/entrez SP - 106 EP - 109 JF - Aerospace medicine and human performance JO - Aerosp Med Hum Perform VL - 91 IS - 2 N2 - BACKGROUND: High-altitude decompression sickness (HADCS) is a rare condition that has been associated with aircraft accidents. To the best of our knowledge, the present paper is the first case report of a patient treated for severe HADCS using recompression therapy and veno-venous extracorporeal oxygenation (VV-ECMO) with a complete recovery.CASE REPORT: After depressurization of a cabin, the 51-yr-old jet pilot was admitted to the Military Institute of Medicine with a life-threatening HADCS approximately 6 h after landing from a high-altitude flight, in a dynamically deteriorating condition, with progressing dyspnea and edema, reporting increasing limb paresthesia, fluctuating consciousness, and right-sided paresis. Hyperbaric oxygen therapy in the intensive care mode was initiated. A therapeutic recompression with U.S. Navy Treatment Table 6 was performed with neurological improvement. Due to cardiovascular collapse, sedation, mechanical ventilation, and significant doses of catecholamines were started, followed by continuous veno-venous hemodialysis. In the face of disturbances in oxygenation, during the second day of treatment the patient was commenced on veno-venous extracorporeal oxygenation. Over the next 6 d, the patient's condition slowly improved. On day 7, VV-ECMO was discontinued. On day 19, the patient was discharged with no neurological deficits.DISCUSSION: We observed two distinct stages during the acute phase of the disease. During the first stage, signs of hypoperfusion, neurological symptoms, and marbled skin were observed. During the second stage, multiple organ dysfunction dominated, including heart failure, pulmonary edema, acute kidney injury, and fluid overload, all of which can be attributed to extensive endothelial damage.Siewiera J, Szałański P, Tomaszewski D, Kot J. High-altitude decompression sickness treated with hyperbaric therapy and extracorporeal oxygenation. Aerosp Med Hum Perform. 2020; 91(2):106-109. SN - 2375-6322 UR - https://www.unboundmedicine.com/medline/citation/31980050/High-Altitude_Decompression_Sickness_Treated_with_Hyperbaric_Therapy_and_Extracorporeal_Oxygenation L2 - https://www.ingentaconnect.com/openurl?genre=article&issn=2375-6314&volume=91&issue=2&spage=106&aulast=Siewiera DB - PRIME DP - Unbound Medicine ER -
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