Emerging treatments
Oxygen pre-breathing
Normobaric oxygen pre-breathing decreases venous gas emboli formation in scuba divers.[52] The mechanism is thought to involve maximising inert gas elimination by increasing the diffusion gradient between nitrogen in the tissues and in the capillaries. While of little utility in scuba diving, this method is used frequently in prevention of high altitude decompression sickness in the aerospace industry.[53]
Tenoxicam
One randomised controlled trial found that tenoxicam, a non-steroidal anti-inflammatory drug, reduced the median number of recompression sessions required from 3 to 2 compared with routine recompression treatment for decompression sickness.[54] However, there was no evidence of improved outcome.[54][55]
Lidocaine
Prospective controlled clinical trials are lacking. In one case report, two patients recovered from decompression illness-induced neural injury with hyperbaric oxygen recompression therapy with adjunctive intravenous lidocaine, despite delayed treatment (>12 hours).[56] In a retrospective cohort study, however, outcomes did not differ between 14 patients who received hyperbaric oxygen and adjunctive intravenous lidocaine for neurologic decompression sickness and cerebral arterial gas embolism, and 21 patients managed with hyperbaric oxygen alone.[57]
Perfluorocarbons
The solubility of respiratory gases in perfluorocarbon emulsions (augmenting local oxygen delivery and increasing the oxygen content in the arterial blood) is of potential interest in the management of decompression sickness without recompression.[58]
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