Conclusions

Dysbaric Illness is generally considered a benign condition. If adequate treatment is started promptly, the success rate is in excess of 80 - 90%.

There is universal consensus that 100% oxygen should be administered immediately as the single most important first aid treatment of any DI case related to surface-oriented diving, and that rehydration is a very valuable first aid measure. Hyperbaric treatment should be started within the shortest possible delay from the onset of the first DI signs and symptoms. Hyperbaric Treatment tables using 100% Oxygen at environmental pressures not exceeding 2.8 ata ensure very good results in the vast majority of cases. There is no evidence that other more complex therapeutic schemes achieve better results in surface-oriented and particularly air diving. For other forms of diving there are guidelines on the use of higher pressures and breathing gases other than 100% oxygen, but experience and appropriate infrastructure is required to perform this safely and effectively.

Although conclusive scientific evidence is lacking for many adjunctive modalities, the administration of fluid therapy is considered very important and generally recommended by diving and hyperbaric medicine specialists. The role of other drugs, such as steroids and anticoagulants, although widely used without any apparent adverse effects, is still controversial.

For neurological DI cases with significant residual deficits, continuation of hyperbaric oxygen therapy in combination with a dedicated rehabilitation protocol is considered important; there is growing scientific evidence that it can contribute significantly to achieving a better functional recovery

117,122,137.

The Consensus Conference System of the ECHM, over the last 10 years, has produced literature that are consistent with international evidence-based medical approaches on matters concerning diving medicine and the treatment of DI. These have now been adopted by the European Union Countries as the common standard of practice.

There are several important areas in need of research, namely: the relationship between gas separation and DI; the relationship between clinical symptoms and the severity of the disease; the relationship between initial clinical onset, treatment results and permanent sequelae; the reason for the large variation in individual susceptibility to DI; the life time of gas bubbles; and the actual incidence of DI. These questions will remain unanswered unless a focused, coordinated and concerted effort is made to solve them. It is hoped that Consensus Conferences and Workshops will continue to pave the way towards uniformity of practice and collaborative research efforts.

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