2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):164−174. doi: 10.28920/dhm52.2.164-174. PMID: 36100927.

Hyperbaric Oxygen for Lower Limb Trauma (HOLLT): an international multi-centre randomised clinical trial

Ian L Millar1,2, Folke G Lind3, Karl-Åke Jansson4, Michal Hájek5,6, David R Smart7,8, Tiago D Fernandes9, Rosemary A McGinnes2, Owen D Williamson2, Russell K Miller10, Catherine A Martin2, Belinda J Gabbe11,12, Paul S Myles13, Peter A Cameron11, for the HOLLT investigator group

1 Department of Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Victoria, Australia
2 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
3 Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
4 Department of Molecular Medicine and Surgery, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
5 Centre of Hyperbaric Medicine, Ostrava City Hospital, Ostrava, Czech Republic
6 Department of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Ostrava-Zabreh, Czech Republic
7 Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
8 School of Medicine, University of Tasmania, Tasmania, Australia
9 Hyperbaric Medicine Unit, Department of Anesthesia, Hospital Pedro Hispano, Matosinhos, Portugal
10 Department of Orthopaedic Surgery, Alfred Health, Melbourne, Victoria, Australia
11 Prehospital, Emergency and Trauma Research Unit, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
12 Health Data Research UK, Swansea University, Swansea, United Kingdom
13 Department of Anaesthesiology and Perioperative Medicine, Alfred Health and Monash University, Melbourne, Victoria, Australia

Corresponding author: Dr Ian Millar, The Alfred Hyperbaric Service, PO Box 315, Prahran, Victoria 3181, Australia
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Keywords
Fractures; Hyperbaric oxygen treatment; Injuries; Musculo-skeletal; Orthopaedics; Outcome; Wounds

Abstract
(Millar IL, Lind FG, Jansson K-A, Hájek M, Smart DR, Fernandes TD, McGinnes RA, Williamson OD, Miller RK, Martin CA, Gabbe BJ, Myles PS, Cameron PA. Hyperbaric Oxygen for Lower Limb Trauma (HOLLT): an international multi-centre randomised clinical trial. Diving and Hyperbaric Medicine. 2022 30 September;52(3):164−174. doi: 10.28920/dhm52.3.164-174. PMID: 36100927.)
Introduction: Hyperbaric oxygen treatment (HBOT) is sometimes used in the management of open fractures and severe soft tissue crush injury, aiming to reduce complications and improve outcomes.
Methods: Patients with open tibial fractures were randomly assigned within 48 hours of injury to receive standard trauma care or standard care plus 12 sessions of HBOT. The primary outcome was the incidence of necrosis or infection or both occurring within 14 days of injury.
Results: One-hundred and twenty patients were enrolled. Intention to treat primary outcome occurred in 25/58 HBOT assigned patients and 34/59 controls (43% vs 58%, odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25 to 1.18, P = 0.12). Tissue necrosis occurred in 29% of HBOT patients and 53% of controls (OR 0.35, 95% CI 0.16 to 0.78, P = 0.01). There were fewer late complications in patients receiving HBOT (6/53 vs 18/52, OR 0.22, 95% CI 0.08 to 0.64, P = 0.007) including delayed fracture union (5/53 vs 13/52, OR 0.31, 95% CI 0.10 to 0.95, P = 0.04). Quality of life measures at one and two years were superior in HBOT patients. The mean score difference in short form 36 was 2.90, 95% CI 1.03 to 4.77, P = 0.002, in the short musculoskeletal function assessment (SMFA) was 2.54, 95% CI 0.62 to 4.46, P = 0.01; and in SMFA daily activities was 19.51, 95% CI 0.06 to 21.08, P = 0.05.
Conclusions: In severe lower limb trauma, early HBOT reduces tissue necrosis and the likelihood of long-term complications, and improves functional outcomes. Future research should focus on optimal dosage and whether HBOT has benefits for other injury types.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):175–182. doi: 10.28920/dhm52.3.175-182. PMID: 36100928.

Influence of atmospheric pressure changes on dentin bond strength of conventional, bulk-fill and single-shade resin composites

Secil Ozkan Ata1, Canan Akay1,2,3, Emre Mumcu1,2,3, Nazim Ata4

1 Department of Prosthodontics, Faculty of Dentistry, Osmangazi University, Eskisehir, Turkey
2 Advanced Material Technologies Application and Research Center, Osmangazi University, Eskisehir, Turkey
3 Translational Medicine Research and Clinical Center, Osmangazi University, Eskisehir, Turkey
4 Aeromedical Research and Training Center, Eskisehir, Turkey

Corresponding author: Dr Secil Ozkan Ata, Department of Prosthodontics, Faculty of Dentistry, Osmangazi University, Eskisehir, Turkey
ORCID: 0000-0003-1756-4390
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Keywords
Aviation medicine; Composite resin; Prosthodontics; Diving medicine; Hyperbaric medicine; Scanning electron microscopy; Teeth

Abstract
(Ata SO, Akay C, Mumcu E, Ata N. Influence of atmospheric pressure changes on dentin bond strength of conventional, bulk-fill and single-shade resin composites. Diving and Hyperbaric Medicine. 2022 30 September;52(3):175–182. doi: 10.28920/dhm52.3.175-182. PMID: 36100928.)
Introduction: The purpose of this study was to investigate the dentin bond strength of composite resins in response to environmental pressure changes.
Methods: Ninety extracted human molar teeth were used. A mould (3 mm x 4 mm) was adapted on dentin, resin composites (conventional [n = 30] and single-shade composites [Ohmnicroma] [n = 30]) were filled in two increments of 2 mm. The bulk-fill composites (n = 30) were filled with one 4 mm increment. The specimens were stored for 30 days in artificial saliva. The specimens were exposed to hyperbaric pressure (283.6 kPa; 2.8 atmospheres absolute [atm abs]) or hypobaric pressure (34.4 kPa; 0.34 atm abs) once daily for 30 days and the control group was stored at atmospheric pressure for 30 days. The bond strength was tested with a universal testing machine and the failures were examined with a stereomicroscope and scanning electron microscope. Statistical analyses were performed using analysis of variance with post hoc tests, and the Weibull analysis.
Results: Regardless of environmental pressure changes, the bulk-fill composites showed the highest bond strength. There was no significant difference in bond strength between the hypobaric and atmospheric pressure (control) groups after 30 days in all resins. The hyperbaric group showed lower bond strength for bulk-fill composites than the control group.
Conclusions: Dentists experienced in diving and aviation medicine should definitely take part in the initial and periodic medical examinations of divers and aircrew to give appropriate treatment. Bulk-fill composite resins can be preferred in divers and aircrew due to high bond strength values.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):183–190. doi: 10.28920/dhm52.3.183-190. PMID: 36100929.

Lung function changes in divers after a single deep helium-oxygen dive

Xiao-chen Bao1, Tao Yang1, Yi-qun Fang1, Yong-jun Sun1, Nan Wang1

1 Department of Diving and Hyperbaric Medicine, Naval Medical Center, Shanghai 200433, China

Corresponding author: Dr Yi-qun Fang, Department of Diving and Hyperbaric Medicine, Naval Medical Center, Shanghai 200433, China
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Keywords
Diving, Heliox; Hyperoxia; Pulmonary function; Surface decompression

Abstract
(Bao X, Yang T, Fang Y, Sun Y, Wang N. Lung function changes in divers after a single deep helium-oxygen dive. Diving and Hyperbaric Medicine. 2022 30 September;52(3):183−190. doi: 10.28920/dhm52.3.183-190. PMID: 36100929.)
Introduction: This study measured pulmonary function in divers after a single helium-oxygen (heliox) dive to 80, 100, or 120 metres of sea water (msw).
Methods: A total of 26 divers participated, of whom 15, five, and six performed a 80, 100, or 120 msw dive, respectively. While immersed, the divers breathed heliox and air, then oxygen during surface decompression in a hyperbaric chamber. Pulmonary function was measured twice before diving, 30 min after diving, and 24 h after diving.
Results: At 30 min after the 80 msw dive the forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio and the maximum expiratory flow at 25% of vital capacity (MEF25) values decreased (89.2% to 87.1% and 2.57 L·s-1 to 2.35 L·s-1, P = 0.04, P = 0.048 respectively) but FEV1/FVC returned to the baseline values by 24 h post-dive. Other pulmonary indicators exhibited downward trends at 30 min after the dive, but statistical significance was lacking. Interestingly, though several parameters decreased after the 100 msw dive, statistical significance was not reached. After the 120 msw dive, the FEV1/FVC and MEF75 decreased (90.4% to 85.6% and 8.05 L·s-1 to 7.46 L·s-1, P = 0.01, P = 0.007). The relatively small numbers of subjects who dived to 100 and 120 msw depths may explain the inconsistent results. The subjects diving to 100 and 120 msw were more trained / skilled, but this would not explain the inconsistencies in results between these depths.
Conclusions: We conclude that single deep heliox dives cause a temporary decrease in FEV1/FEV and MEF25 or MEF75, but these changes can recover at 24 h after the dive.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):191−196. doi: 10.28920/dhm52.3.191-196. PMID: 36100930.

Pretreatment hearing grades and hearing recovery outcomes after primary hyperbaric oxygen treatment in patients with idiopathic sudden sensorineural hearing loss

Andrijana Včeva1,2, Željko Zubčić1,2, Hrvoje Mihalj1,2, Josip Maleš1,2, Tihana Mendeš1,2, Anamarija Šestak1,2

1 Department of Otorhinolaryngology and Maxillofacial Surgery, Medical Faculty, University of Osijek, J. Huttlera 4, 31000 Osijek, Croatia
2 Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Osijek, J. Huttlera 4, 31000 Osijek, Croatia

Corresponding author: Dr Anamarija Šestak, Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Osijek, J. Huttlera 4, 31000 Osijek, Croatia
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Keywords
Clinical audit; Deafness; ENT; Hyperbaric research; Otorhinolaryngology, Outcome

Abstract
(Včeva A, Žubčić Ž, Mihalj H, Maleš J, Mendeš T, Šestak A. Pretreatment hearing grades and hearing recovery outcomes after primary hyperbaric oxygen treatment in patients with idiopathic sudden sensorineural hearing loss. Diving and Hyperbaric Medicine. 2022 30 September;52(3):191−196. doi: 10.28920/dhm52.3.191-196. PMID: 36100930.)
Introduction: Previous studies suggest the effectiveness of hyperbaric oxygen treatment (HBOT) in idiopathic sudden sensorineural hearing loss (ISSNHL) but it is mostly used as an adjuvant and salvage treatment. This study evaluated the effect of primary HBOT according to pretreatment hearing grades and hearing recovery outcomes using modified Siegel’s criteria in patients with ISSNHL.
Methods: Fifty-nine ISSNHL patients treated with only HBOT were included. A pure-tone audiogram was recorded before and after a course of HBOT (90 min at 203 kPa daily for 20 days). Using the modified Siegel’s criteria, patients were divided into groups according to hearing threshold before and after treatment.
Results: Hearing thresholds were significantly lower after HBOT compared to pre-treatment values across all patients
(P < 0.001) with a median value of recovery of 22.5 dB (interquartile range 12.5−33.7 dB). Significantly lower hearing threshold values were recorded at 500, 1,000, 2,000, and 4,000 Hz after treatment (P < 0.001). The greatest recovery was at 1,000 Hz, (change in median threshold = 32 dB) but without a significant difference compared to other frequencies (P = 0.10).
Conclusions: HBOT is a legitimate choice as the primary treatment for ISSNHL, especially if it is readily accessible, and if there are contraindications for corticosteroid therapy.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):197−207. doi: 10.28920/dhm52.3.197-207. PMID: 36100931.

The role of routine pulmonary imaging before hyperbaric oxygen treatment

Connor TA Brenna1,2, Shawn Khan2, George Djaiani3, Jay C Buckey Jr.4, Rita Katznelson1,3

1 Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
2 Faculty of Medicine, University of Toronto, Toronto, ON, Canada
3 Department of Anesthesia, University Health Network, Toronto, ON, Canada
4 Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA

Corresponding author: Dr Rita Katznelson, Toronto General Hospital, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
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Keywords
Arterial gas embolism; Lung; Pneumothorax; Pulmonary barotrauma; Radiological imaging; Risk assessment

Abstract

(Brenna CTA, Khan S, Djaiani G, Buckey JC Jr, Katznelson R. The role of routine pulmonary imaging before hyperbaric oxygen treatment. Diving and Hyperbaric Medicine. 2022 30 September;52(3):197−207. doi: 10.28920/dhm52.3.197-207. PMID: 36100931.)
Respiratory injury during or following hyperbaric oxygen treatment (HBOT) is rare, but associated pressure changes can cause iatrogenic pulmonary barotrauma with potentially severe sequelae such as pneumothoraces. Pulmonary blebs, bullae, and other emphysematous airspace abnormalities increase the risk of respiratory complications and are prevalent in otherwise healthy adults. HBOT providers may elect to use chest X-ray routinely as a pre-treatment screening tool to identify these anomalies, particularly if a history of preceding pulmonary disease is identified, but this approach has a low sensitivity and frequently provides false negative results. Computed tomography scans offer greater sensitivity for airspace lesions, but given the high prevalence of incidental and insignificant pulmonary findings among healthy individuals, would lead to a high false positive rate because most lesions are unlikely to pose a hazard during HBOT. Post-mortem and imaging studies of airspace lesion prevalence show that a significant proportion of patients who undergo HBOT likely have pulmonary abnormalities such as blebs and bullae. Nevertheless, pulmonary barotrauma is rare, and occurs mainly in those with known underlying lung pathology. Consequently, routinely using chest X-ray or computed tomography scans as screening tools prior to HBOT for low-risk patients without a pertinent medical history or lack of clinical symptoms of cardiorespiratory disease is of low value. This review outlines published cases of patients experiencing pulmonary barotrauma while undergoing pressurised treatment/testing in a hyperbaric chamber and analyses the relationship between barotrauma and pulmonary findings on imaging prior to or following exposure. A checklist and clinical decision-making tool based on suggested low-risk and high-risk features are offered to guide the use of targeted baseline thoracic imaging prior to HBOT.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Review article


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):208−212. doi: 10.28920/dhm52.3.208-212. PMID: 36100932.

Effect of hyperbaric oxygen treatment on skin elasticity in irradiated patients

Karan Pandey1, David N Teguh1, Robert A van Hulst1,2

1 Department of Surgery/Hyperbaric Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
2 Department of Anesthesiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands

Corresponding author: Karan Pandey, Department of Hyperbaric Medicine, Amsterdam University Medical Centre, Location AMC, Amsterdam, The Netherlands
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Keywords
Breast cancer; Fibrosis; Late radiation tissue injuries; Radiotherapy; Radionecrosis

Abstract
(Pandey K, Teguh DN, van Hulst RA. Effect of hyperbaric oxygen treatment on skin elasticity in irradiated patients. Diving and Hyperbaric Medicine. 2022 30 September;52(3):208−212. doi: 10.28920/dhm52.3.208-212. PMID: 36100932.)
Background: Hyperbaric oxygen treatment (HBOT) is often used in an attempt to reverse/treat late radiation-induced tissue fibrosis (LRITF). This study aimed to quantify the effects on skin elasticity.
Methods: Skin retraction time was used as a marker of skin elasticity in 13 irradiated breast cancer patients. The measurements were carried out on the affected side as well as the unaffected/healthy side at a mirrored location. Readings were taken at the start and end of HBOT (mean 43 sessions, 80 min at 243 kPa).
Results: Patient age ranged from 39–70 years. All patients underwent surgical lumpectomy and radiotherapy prior to undergoing HBOT. The mean time between radiotherapy and HBOT was 70 months. Seven of the 13 patients underwent chemotherapy. Mean irradiated skin retraction time improved from 417 (SD 158) pre-HBOT to 171 (24) msec post-HBOT (P < 0.001). Mean pre-HBOT retraction time in the non-irradiated skin was 143 (20) msec and did not change.
Conclusions: This promising pilot study that suggests that HBOT may improve skin elasticity in patients with LRITF.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Short Communication


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):213−216. doi: 10.28920/dhm52.3.213-216. PMID: 36100933.

Recurrent dysbarism presenting with amnesia and hypoaesthesia in a professional breath-hold diver

Emily Diacono1, Kurt Magri2

1 University of Malta, Msida, Malta
2 Baromedicine Department, Hyperbaric Unit, Mater Dei Hospital, Msida, Malta

Corresponding author: Ms Emily Diacono, University of Malta, Msida, Malta
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Keywords
Breath-hold diving; Decompression sickness; Hyperbaric oxygen; Apnoea; Free diving

Abstract

(Diacono E, Magri K. Recurrent dysbarism presenting with amnesia and hypoaesthesia in a professional breath-hold diver. Diving and Hyperbaric Medicine. 2022 30 September;52(3):213−216. doi: 10.28920/dhm52.3.213-216. PMID: 36100933.)
Dysbarism is a medical condition arising from change in ambient pressure which outpace the rate at which the body adapts to it. We report a case of recurrent dysbarism consistent with possible decompression illness presenting with amnesia, hypoaesthesia and other neurological manifestations in a professional breath-hold diver treated successfully with hyperbaric oxygen and fluid resuscitation.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Case Report


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):217−220. doi: 10.28920/dhm52.3.217-220. PMID: 36100934.

Takotsubo cardiomyopathy findings on cardiac magnetic resonance imaging following immersion pulmonary oedema

Rosanna J Stokes1, Ross Sayers1, Benjamin J Sieniewicz2, Wan Cheol Kim3

1 DDRC Healthcare, Science Park, Plymouth, UK
2 Department of Cardiology, University Hospitals Plymouth, Plymouth, UK
3 Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK

Corresponding author: Dr Rosanna J Stokes, DDRC Healthcare, Science Park, Plymouth, UK
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Keywords
Cardiovascular; Case reports; Diving incidents; Diving medicine

Abstract

(Stokes RJ, Sayers R, Sieniewicz BJ, Kim WC. Takotsubo cardiomyopathy findings on cardiac magnetic resonance imaging following immersion pulmonary oedema. Diving and Hyperbaric Medicine. 2022 30 September;52(3):217−220. doi: 10.28920/dhm52.3.217-220. PMID: 36100934.)
Immersion pulmonary oedema (IPO) can affect sea swimmers, snorkelers, and scuba divers. It can be fatal and cases are often mistaken for drowning. There has been an association between IPO and the development of takotsubo cardiomyopathy. We present a case study of a diver rescued from the water with IPO, who was subsequently found to have takotsubo cardiomyopathy on cardiac magnetic resonance imaging (CMR). This case demonstrates CMR findings as well as follow- up investigation results. The diver’s and instructor’s perspective during the initial dive incident are also described.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Case Report


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):221-222. doi: 10.28920/dhm52.3.221-222. PMID: 36100935.

Comment regarding: Han K-H, Hyun G-S, Jee Y-S, Park J-M. Effect of water amount intake before scuba diving on the risk of decompression sickness. Int J Environ Res Publ Health. 2021;18:7601

Neal W Pollock1,2, S Lesley Blogg3, Jan Risberg4

1 Université Laval, Québec, QC, Canada
2 Service de médecine hyperbare, Centre de médecine de plongée du Québec, Hôtel-Dieu de Lévis, Lévis, QC, Canada
3 SLB Consulting, Home Park Barn, Newbiggin on Lune, Cumbria, United Kingdom
4 NUI, Bergen, Norway

Corresponding author: Neal W Pollock, Université Laval, Québec, QC, Canada
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Keywords
Decompression; Diving; Ultrasound; Safety; Physiology; Science publication

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Letter


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):222-223. doi: 10.28920/dhm52.3.222-223. PMID: 36100936.

Validation of very mild COVID-19 illness criteria to guide successful return to occupational diving

David Smart

Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, 26 Campbell St, Hobart, Tasmania 7000, Australia

Address for correspondence: Clinical Professor David Smart, iN2Deep Medical Consulting, GPO Box 463, Hobart, Tasmania 7001, Australia.
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Keywords
Diving Medicine; Health surveillance; Medicals-diving; SARS-CoV-2; Lung function

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Letter


2022 September;52(3) 

Diving Hyperb Med. 2022 September 30;52(3):223-224. doi: 10.28920/dhm52.3.223-224. PMID: 36100937.

Recompression of a diver with decompression illness found to be COVID-19 positive

Louise Mallam,1 Doug Watts1

1 DDRC Healthcare, Science Park, Plymouth PL6 8BU, United Kingdom

Address for correspondence: Dr Doug Watts, Medical Director, DDRC Healthcare, Science Park, Plymouth PL6 8BU, United Kingdom
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Keywords
Decompression sickness; Diving Medicine; Infection control; SARS-CoV-2

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Letter

 

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Articles from 2017 are deposited in PubMed Central