Israel Medical Association Journal

Background: Decompression sickness (DCS) is a clinical syndrome caused by a substantial reduction in barometric pressure. DCS is more common among divers but may also occur during flight or altitude chamber (hypobaric chamber) training. DCS is classified according to symptoms as either Type 1 (musculoskeletal and skin involvement) or Type 2 (neurological and pulmonary involvement). DCS may be life threatening and often necessitates treatment with hyperbaric oxygen therapy (HBOT).

Objectives: To examine the risk for altitude decompression sickness (ADCS) in altitude chamber training and to compare ADCS symptoms and treatment to those of DCS in divers (DDCS).

Methods: We conducted a retrospective cohort study that included all cases of ADCS in the Israeli Air Force between 2015 to 2022. We collected demographic, flight platform, altitude chamber training, clinical manifestations, and treatment data. Data regarding DDCS was obtained via a literature review.

Results: There were 2279 altitude chamber trainees and aviation physiology instructors. Of these, 11 presented ADCS, leading to a calculated ADCS risk of 0.5%. An additional four cases were reported following combat flights. Musculoskeletal involvement was the most common symptom in both DDCS and ADCS. A shorter HBOT protocol was used in 53% of the ADCS cases but only in 30% of the DDCS cases.

Conclusions: Overall, ADCS is a rare event, occurring in less than 1% of altitude chamber trainees. The common manifestation is of musculoskeletal involvement, and the mainstay of treatment remains HBOT.

For most passengers, even those with respiratory disease, air travel is safe and comfortable. Some travelers may experience hypoxia at sea level but may not need supplemental oxygen during air travel in a hypobaric hypoxic environment. For some individuals compensatory pulmonary mechanisms may be inadequate, causing profound hypoxia. In addition, venous thromboembolism/pulmonary emboli may occur, especially during long haul flights. With adequate screening, patients at risk can be identified, therapeutic solutions can be proposed for the flight, and most can travel can continue safely with supplemental oxygen and other preventive measures.

Background: As the lowest natural site on earth (-415 meters), the Dead Sea is unique for its high pressure and oxygen tension in addition to the unparalleled combination of natural resources. Furthermore, its balneotherapeutic resorts have been reported to be beneficial for patients with various chronic diseases.

Objectives: To evaluate the safety, quality of life (QoL), exercise capacity, heart failure, and arrhythmia parameters in patients with systolic congestive heart failure (SCHF) and implantable cardioverter defibrillator (ICD) following descent and stay at the Dead Sea.

Methods: The study group comprised patients with SCHF, New York Heart Association functional class II-III after ICD implantation. The following parameters were tested at sea level one week prior to the descent, during a 4 day stay at the Dead Sea, and one week after return: blood pressure, O₂ saturation, ejection fraction (echocardiography), weight, B-type natriuretic peptide (BNP), arrhythmias, heart rate, heart rate variability (HRV), and QoL assessed by the Minnesota Living with Heart Failure questionnaire.

Results: We evaluated 19 patients, age 65.3 ± 9.6 years, of whom 16 (84%) were males and 18 (95%) had ICD-cardiac resynchronization therapy. The trip to and from and the stay at the Dead Sea were uneventful and well tolerated. The QoL score improved by 11 points, and the 6 minute walk increased by 63 meters (P < 0.001). BNP levels slightly increased with no statistical significance. The HRV decreased (P = 0.018). There were no significant changes in blood pressure, weight, O₂ saturation or ejection fraction.

Conclusions: Descent to, ascent from, and stay at the Dead Sea resort are safe and might be beneficial in some aspects for patients with sCHF and an ICD.