RESUMEN
INTRODUCTION: Numerous studies have been conducted to identify the factors influencing the short-term prognosis for neurological decompression sickness (DCS). However, the long-term sequelae are rarely assessed. The purpose of this study to investigate the factors likely to influence the long-term prognosis. METHODS: Twenty-seven Vietnamese fishermen-divers who on average 9 (SD 6) years beforehand had presented with neurological DCS and ongoing sequelae, were questioned and examined. The severity of the initial clinical profile was quantified using a severity score. The long-term sequelae were clinically evaluated by looking for a motor or sensory deficit or muscular spasticity, and by applying a severity score for the sequelae which focussed on gait and sphincter disorders. RESULTS: An initial severity score of ≥ 15 is significantly associated with a risk of serious long-term sequelae [OR = 13.7 (95% CI 2.4 to 79.5)]. Furthermore, certain treatment practices such as in-water recompression to depths > 17 metres' seawater breathing air are significantly associated with more serious sequelae. The practice of intensive non-standardised hyperbaric oxygen sessions over prolonged durations (median 30 days [IQR 19.5]) delayed after the initial accident (median 4 days [IQR 6]) also seems unfavourable. CONCLUSION: This study establishes a link between the initial DCS severity and the long-term sequelae causing severe gait disorders and sphincter incontinence. Furthermore, this work suggests that certain detrimental treatment practices should be modified. During this field study, we also found that it was possible to reduce sequelae of these divers by offering them an individual programme of self-rehabilitation.
Asunto(s)
Enfermedad de Descompresión , Buceo , Oxigenoterapia Hiperbárica , Adulto , Descompresión , Humanos , Persona de Mediana Edad , OxígenoRESUMEN
INTRODUCTION: Many fisherman divers in Vietnam suffer from decompression sickness (DCS) causing joint pain, severe neurological deficit or even death. The objective of this pilot study was to evaluate the effectiveness of a training programme to prevent DCS and also treat DCS using the method of in-water recompression (IWR). METHODS: 63 divers were interviewed and trained over a period of 3â years from 2009. Fifty one per cent of all trained divers were reinterviewed in 2011-2012 to collect mortality and morbidity data as well as information on changes in diving practices. RESULTS: Since 2009, most fisherman divers have changed their practices by reducing bottom time or depth. Mortality was reduced and the incidence of severe neurological DCS decreased by 75%. Twenty four cases of DCS were treated by IWR. Ten cases of joint pain were treated with IWR using air, affording immediate relief in all cases. Out of 10 cases of neurological DCS, 4/4 recovered completely after IWR with oxygen whereas only 2/6 subjects recovered immediately after IWR with air. In addition, 3/4 further cases of DCS treated with IWR using oxygen immediately recovered. CONCLUSIONS: Our results suggest that IWR is effective for severe neurological DCS in remote fishing communities, especially with oxygen.