Fiji’s multi-million-dollar diving industry has received an added boost following the installation of a state-of-the-art hyperbaric chamber at the Pacific Specialist Healthcare (PSH) Hospital in Nadi.
In 2011, the shark-diving industry alone contributed $42.2million to Fiji’s economy making the diving industry a key part of the tourism industry.
Cognisant of this and the needs of the industry, PSH has embarked on a joint venture with the Republic of Fiji Navy (RFN) to offer this newest facility at their Nadi hospital.
Below is a condensation of Dr Vereniki Raiwalui’s paper on hyberbaric medicine for diving-related complications. Dr Raiwalui will be in-charge of the new HyperBaric Oxygen Therapy (HBOT) service that will now be available to the public at PSH Nadi.
The new machine was officially launched by the Deputy Prime Minister and Minister for Finance Prof Biman Prasad on Tuesday December 31, 2024.
HYPERBARIC medicine has emerged as a critical intervention for diving-related complications, primarily decompression sickness (DCS) and arterial gas embolism (AGE). This review focuses on current practices, efficacy, and recommendations from authoritative bodies such as the South Pacific Underwater Medicine Society (SPUMS) and the Divers Alert Network (DAN).
Decompression sickness and Hyperbaric Oxygen Therapy (HBOT).
Decompression sickness occurs when divers ascend too quickly, leading to the formation of nitrogen bubbles in the body. HBOT has been established as a primary treatment method. SPUMS has emphasised its critical role in the management of DCS, suggesting that HBO therapy should be considered within the first six hours of symptom onset for optimal results (Bennett & Elliott, 1993).
The protocol generally involves multi-place chambers, where the patient breathes 100per cent oxygen at pressures typically between 2.0 to 3.0 ATA (atmospheres absolute).
DAN has published extensive guidelines on HBOT, advocating for its use in DCS cases along with personalised care plans that may include repetitive HBOT sessions depending on the severity of the condition (DAN, 2020). These guidelines support early referral to hyperbaric facilities and emphasise the importance of follow-up evaluations.
Arterial gas embolism (AGE)
AGE, another serious diving-related complication, occurs when gas bubbles enter the bloodstream, potentially leading to life-threatening consequences. HBOT has been shown to reduce the size of emboli and improve neurological outcomes (Davis et al., 2009). The SPUMS guidelines suggest immediate recompression therapy at levels of 2.5 ATA with continuous monitoring of the patient’s neurological status during treatment (SPUMS, 2016).
According to DAN, the therapeutic effects of HBOT in treating AGE are attributed to several mechanisms, including reducing bubble size, increasing oxygen delivery to compromised tissues, and mitigating hypoxia-induced injury (DAN, 2021).
Both SPUMS and DAN emphasise the need for a rapid response in AGE cases, citing studies that demonstrate how timely intervention can significantly alter outcomes.
Controversies and future directions
Despite the well-documented benefits of HBOT, some controversies exist regarding the optimal treatment duration and pressure levels (Nicol et al., 2018). Research continues on the long-term effects of HBOT and the potential for hyperbaric interventions in cases of minor DCS or after repetitive dives, where traditional treatment protocols may not be as effective.
Conclusion
Hyperbaric medicine, particularly HBOT, stands as a cornerstone in the treatment of diving-related complications, with clear guidelines provided by SPUMS and DAN reinforcing its efficacy. Continued research is necessary to refine treatment protocols, address potential controversies, and ensure the best possible outcomes for divers.
DR VERENIKI RAIWALUI is a consultant Anaesthesiologist, consultant Intensivist and director of Anaesthesiology and Intensive Care Medicine at the Pacific Specialist Healthcare Hospital in Nadi, Fiji. The views expressed in this article are the author’s and not necessarily the views of The Fiji Times.
NOTE: This article was first published in the print edition of the Fiji Times dated January 04, 2025.