Monitoring

In general, no monitoring is required once decompression sickness, cerebral air embolism, or barotrauma have fully resolved. Appropriate follow-up during recovery will depend on the individual circumstances. In certain situations, such as pulmonary barotrauma or permanent symptoms of neurological decompression sickness or cerebral arterial gas embolism, further diving may be contraindicated. Nitrogen narcosis resolves spontaneously and usually does not require follow-up.

Ideally, all seriously injured divers should be evaluated by a physician with experience in diving medicine prior to return to diving.[66]​ The question of a suitable timescale for resumption of diving is unanswered. There is evidence to suggest that bubbles persist after apparently successful recompression for decompression sickness after a saturation exposure.[67]​ Military, scientific, and commercial organisations have their own return to diving guidelines.[68]​ There is no consensus as to the return to diving for the injured recreational diver. It is generally advised that 7 days to 3 months should elapse before a return to diving is considered.[66]​ This is an appropriate time at which to re-evaluate neurological status and assess risk factors for future injury. Commercial or institutional pressures will, however, shorten this period on occasion, particularly in type I cases.[3]

At post-injury evaluation, several issues need to be addressed:

  • Treatment response

  • Presence of residual symptoms or signs attributable to decompression sickness or barotrauma

  • Presence of correctable predisposing factors to further decompression sickness or barotrauma

In cases where the severity of the decompression sickness was out of proportion to the dive exposure, a reason for this increased susceptibility should be sought (e.g., pulmonary barotrauma, patent foramen ovale).

Routine screening for patent foramen ovale is not indicated, although it is advised in cases of 'undeserved', severe, or recurrent cutaneous or neurological decompression sickness.[69]

Divers with inner ear decompression sickness should have a full vestibular evaluation, including an ectro-nystagmagram, and be seen by an otolaryngologist prior to returning to diving.

A diver with arterial gas embolism without a provocative event (e.g., rapid ascent or breath holding) may be evaluated for a structural lung abnormality with a high resolution lung CT; however, many divers with blebs or cysts dive without complication.[70]​ This makes the evaluation and counselling of a diver with an 'undeserved' arterial gas embolism who wants to return to diving difficult. A diver should wait at least 3 months after pulmonary barotrauma before returning to diving.[66]

Bone-imaging techniques (e.g., x-ray, bone scan, CT, and MRI) are useful for recognition of dysbaric osteonecrosis, prompting modification, or cessation of diving practices, although their use in surveillance of divers at high risk is controversial.[71][72]

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