What criteria should I use to determine whether a patient with decompression sickness requires hyperbaric oxygen therapy?

Criteria for determining the need for hyperbaric oxygen therapy (HBOT) in decompression sickness (DCS) include the presence of clinical symptoms consistent with DCS, such as joint pain, neurological deficits, cardiopulmonary symptoms, or cutaneous manifestations. Patients exhibiting any neurological signs (e.g., numbness, weakness, altered consciousness), severe pain unresponsive to initial management, or cardiopulmonary compromise should be prioritized for HBOT ¹. Additionally, the timing of symptom onset relative to decompression is critical; symptoms appearing shortly after surfacing increase the urgency for HBOT. The severity and progression of symptoms guide the decision, with more severe or worsening symptoms indicating a stronger need for immediate HBOT ¹. Diagnostic confirmation through clinical assessment and exclusion of other causes is essential, but treatment should not be delayed if DCS is strongly suspected. Recent evidence supports that early initiation of HBOT improves outcomes by reducing bubble size and promoting tissue oxygenation, thus mitigating ischemic injury (Jüttner and Tetzlaff, 2015). In summary, the decision to initiate HBOT is based on clinical presentation severity, symptom type (especially neurological or cardiopulmonary), timing, and progression, with early treatment favored to optimize recovery. ¹ (Jüttner and Tetzlaff, 2015)