Overview
Decompression sickness and arterial gas embolism are the original and most strongly validated HBOT indications. US Navy Treatment Table 6 (60-foot-equivalent dive with oxygen breathing periods) remains the gold standard recompression protocol worldwide.
Decompression sickness (DCS) and arterial gas embolism (AGE) are diving injuries caused by gas bubbles forming in blood and tissue when pressure decreases faster than inert gas can diffuse out. Symptoms range from joint pain and skin manifestations (Type I DCS) to neurological deficits, cardiopulmonary collapse, and death (Type II DCS). AGE results from pulmonary barotrauma releasing air directly into arterial circulation — a true emergency.
Treatment is immediate recompression using US Navy Treatment Table 6 (standard DCS/AGE protocol): compression to 2.8 ATA (60 feet of seawater equivalent) with scheduled oxygen breathing periods and gradual decompression. Table 6A is used for severe or recurrent cases. Treatment can last 5–8 hours per session. Delivery is typically in large multiplace chambers at tertiary hyperbaric facilities, military dive support vessels, or commercial diving facilities.
This is the original HBOT indication — the clinical use that drove the development of hyperbaric medicine as a specialty. Decades of case series and the US Navy Diving Manual tables provide the authoritative treatment framework. Formal RCTs are ethically infeasible given life-threatening presentations.
How HBOT Works for This Condition
Recompression reduces bubble size by increasing ambient pressure, allowing dissolved inert gas to redistribute. Oxygen breathing eliminates nitrogen from blood (nitrogen washout) and provides tissue oxygenation to ischaemic regions. Gradual decompression allows safe elimination of the dissolved gas load without recurrence of bubbles.
GRADE Evidence Rating
US Navy Treatment Table 6 has decades of clinical use. RCT impractical (life-threatening emergency). Universal standard of care.
| GRADE Domain | Assessment |
|---|---|
| Risk of bias | Low |
| Consistency | Consistent |
| Directness | Direct |
| Precision | Precise |
GRADE methodology: Grading of Recommendations Assessment, Development and Evaluation. See GRADE Working Group.
Clinical Protocol
| Typical protocol | US Navy Table 6 (2.8 ATA with periodic oxygen) — single acute treatment |
|---|---|
| Evidence level | Standard of care — Universal |
| FDA status | Primary FDA-approved indication |
Table 6: compression to 60 fsw (2.8 ATA), oxygen breathing periods alternating with air breaks, gradual decompression over 4–5 hours total. Table 6A: extended version for severe or recurrent cases, up to 8+ hours. Additional sessions as needed for persistent or recurrent symptoms.
Evidence Base
DCS/AGE HBOT is standard of care globally. UHMS Tier 1. Decades of clinical experience plus military and commercial diving data provide the evidence base. No modern RCT (ethically infeasible).
Cautions & Considerations
- Time-critical — initiate immediately on diagnosis.
- Requires 24/7 hyperbaric facility access (DAN emergency hotline helps locate).
- Severe cases may require multiple treatments.
- Divers Alert Network (DAN) coordinates US emergency response.
Key Research & References
- US Navy Diving Manual (current revision)
- Divers Alert Network registries
- UHMS Indications Manual
Indexed Studies for This Condition
Linked entries in the HBOT Studies Database.
Frequently Asked Questions
How quickly must DCS be treated?
As quickly as possible. Benefit diminishes with delay, though recompression can still be effective hours to days after symptom onset for selected cases. Call DAN (+1-919-684-9111 24/7) for emergency guidance in the US.
Can HBOT prevent DCS?
No. DCS prevention is via proper dive-planning (safe ascent rates, decompression stops, conservative tables/computers). HBOT is treatment, not prevention.
Who delivers DCS HBOT?
Specialised hyperbaric facilities with multiplace chambers, often at coastal hospitals or university centres. The DAN hotline helps locate the nearest capable facility.
Research disclaimer: This article summarises published research for educational purposes only. Nothing here is medical advice. HBOT is a prescription medical treatment that must be administered under physician supervision in appropriately certified chambers. Discuss any treatment decisions with a qualified clinician.