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Vascular hyperpermeability in pulmonary decompression illness: ‘The chokes’
Author(s) -
Kondo Yutaka,
Shiohira Shinya,
Kamizato Kota,
Teruya Koji,
Fuchigami Tatsuya,
Kakinohana Manabu,
Kukita Ichiro
Publication year - 2012
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/j.1742-6723.2012.01582.x
Subject(s) - medicine , procalcitonin , intensive care unit , decompression illness , anesthesia , shock (circulatory) , sepsis , decompression , respiratory failure , intensive care medicine , decompression sickness , surgery
Decompression illness ( DCI ) develops during or after diving. Pulmonary decompression illness (‘ C hokes’) 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 C hokes.