Vascular hyperpermeability in pulmonary decompression illness: ‘The chokes’

Authors


  • Yutaka Kondo, MD, Instructor of Emergency Medicine; Shinya Shiohira, MD, Resident of Emergency Medicine; Kota Kamizato, MD, Instructor of Anesthesiology and Intensive Care Medicine; Koji Teruya, MD, Instructor of Anesthesiology and Intensive Care Medicine; Tatsuya Fuchigami, MD, PhD, Assistant Professor of Anesthesiology and Intensive Care Medicine; Manabu Kakinohana, MD, PhD, Associate Professor of Anesthesiology and Intensive Care Medicine; Ichiro Kukita, MD, PhD, Professor of Emergency Medicine.

Correspondence: Dr Yutaka Kondo, Department of Emergency Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. Email: kondokondou2000@yahoo.co.jp

Abstract

Decompression illness (DCI) develops during or after diving. Pulmonary decompression illness (‘Chokes’) is rarely seen because the affected individual usually dies in the water. We encountered a rare and interesting case. A 60-year-old man complained of leg pain after diving. Despite rapid transfer to a nearby hospital, advanced respiratory failure and shock had set in. He was then transferred to our hospital for hyperbaric oxygen therapy (HBOT). On account of his poor general condition, we initially treated him in the intensive care unit without HBOT, where he showed extreme hyperpermeability and a high level of serum procalcitonin (PCT; 20.24 ng/mL). Despite large-volume fluid therapy, severe intravascular dehydration and shock status remained. We assume that the injured endothelial cells induced vascular hyperpermeability and increased levels of inflammatory cytokines leading to the high serum PCT level. PCT might be a useful stress marker of endothelial damage and severity in DCI, including Chokes.

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