Abstract
Purpose
Deep diving using mixed gas with closed-circuit rebreathers (CCRs) is increasingly common. However, data regarding the effects of these dives are still scarce. This preliminary field study aimed at evaluating the acute effects of deep (90–120 msw) mixed-gas CCR bounce dives on lung function in relation with other physiological parameters.
Methods
Seven divers performed a total of sixteen open-sea CCR dives breathing gas mixture of helium, nitrogen and oxygen (trimix) within four days at 2 depths (90 and 120 msw). Spirometric parameters, SpO2, body mass, hematocrit, short term heart rate variability (HRV) and critical flicker fusion frequency (CFFF) were measured at rest 60 min before the dive and 120 min after surfacing.
Results
The median [1st–3rd quartile] of the forced vital capacity was lower (84% [76–93] vs 91% [74–107] of predicted values; p = 0.029), whereas FEV1/FVC was higher (98% [95–99] vs 95% [89–99]; p = 0.019) after than before the dives. The other spirometry values and SpO2 were unchanged. Body mass decreased from 73.5 kg (72.0–89.6) before the dives to 70.0 kg (69.2–85.8) after surfacing (p = 0.001), with no change of hematocrit or CFFT. HRV was increased as indicated by the higher SDNN, RMSSD and pNN50 after than before dives.
Conclusion
The present observation represents the first original data regarding the effects of deep repeated CCR dives. The body mass loss and decrease of FVC after bounce dives at depth of about 100 msw may possibly impose an important physiological stress for the divers.
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Availability of data and material
The datasets generated during the current study are available from the corresponding author on reasonable request.
Abbreviations
- ANOVA:
-
Analysis of variance
- ApEn:
-
Approximate entropy
- BF:
-
Body fat
- BMI:
-
Body mass index
- BML:
-
Body mass loss
- CCR:
-
Closed circuit rebreather
- CFFF:
-
Critical flicker fusion frequency
- DCS:
-
Decompression sickness
- DFA:
-
Detrended fluctuations
- ECG:
-
Electrocardiogram
- EVLW:
-
Extravascular lung water
- FEF25–75:
-
Forced expiratory flow at 25 and 75%
- FEV1:
-
Forced expiratory volume in 1 s
- FVC:
-
Forced vital capacity
- He:
-
Helium
- HF:
-
High frequency
- HR:
-
Heart rate
- HRV:
-
Heart rate variability
- Ht:
-
Hematocrit
- GLI:
-
Global lung initiative
- LF:
-
Low frequency
- MET:
-
Metabolic equivalent of the task
- msw:
-
Meter of sea water
- O2:
-
Oxygen
- pNN50:
-
Proportion of pairs of successive NN (R-R) intervals that differ by more than 50 ms
- PEF:
-
Peak expiratory flow
- Po2:
-
Oxygen partial pressure
- RMSSD:
-
Root mean square of the successive differences
- scuba:
-
Self-contained underwater breathing apparatus
- SD:
-
Standard deviation
- SDNN:
-
Standard deviation of the NN (R-R) intervals
- ShanEn:
-
Shannon entropy
- SpO2:
-
Oxygen saturation
- ULC:
-
Ultrasonic lung comets
- UTP3:
-
Under the pole 3 expedition
References
Arieli R (2019) Calculated risk of pulmonary and central nervous system oxygen toxicity: a toxicity index derived from the power equation. Diving Hyperb Med 49:154–160. https://doi.org/10.28920/dhm49.3.154-160
Bao X-C, Chen H, Fang Y-Q et al (2015) Clopidogrel reduces the inflammatory response of lung in a rat model of decompression sickness. Respir Physiol Neurobiol 211:9–16. https://doi.org/10.1016/j.resp.2015.02.003
Barbosa E, García-Manso JM, Martín-González JM et al (2010) Effect of hyperbaric pressure during scuba diving on autonomic modulation of the cardiac response: application of the continuous wavelet transform to the analysis of heart rate variability. Mil Med 175:61–64. https://doi.org/10.7205/MILMED-D-02-00808
Bosco G, Rizzato A, Quartesan S et al (2018) Spirometry and oxidative stress after rebreather diving in warm water. Undersea Hyperb Med 45:191–198
Brubakk AO, Ross JAS, Thom SR (2014) Saturation diving; physiology and pathophysiology. In: Terjung R (ed) Comprehensive physiology. John Wiley & Sons Inc, Hoboken, NJ, USA, pp 1229–1272
Castagna O, Blatteau J-E, Vallee N et al (2013) The underestimated compression effect of neoprene wetsuit on divers hydromineral homeostasis. Int J Sports Med 34:1043–1050. https://doi.org/10.1055/s-0033-1345136
Castagna O, Desruelle A, Blatteau J-E et al (2015) Alterations in body fluid balance during fin swimming in 29 °C water in a population of special forces divers. Int J Sports Med 36:1125–1133. https://doi.org/10.1055/s-0035-1555854
Castagna O, Gempp E, Poyet R et al (2017) Cardiovascular mechanisms of extravascular lung water accumulation in divers. Am J Cardiol 119:929–932. https://doi.org/10.1016/j.amjcard.2016.11.050
Castagna O, Regnard J, Gempp E et al (2018) The key roles of negative pressure breathing and exercise in the development of interstitial pulmonary edema in professional male SCUBA divers. Sports Med-Open. https://doi.org/10.1186/s40798-017-0116-x
Castagna O, Bergmann C, Blatteau JE (2019) Is a 12 h nitrox dive hazardous for pulmonary function? Eur J Appl Physiol 119:2723–2731. https://doi.org/10.1007/s00421-019-04248-w
Chouchou F, Pichot V, Garet M et al (2009) Dominance in cardiac parasympathetic activity during real recreational SCUBA diving. Eur J Appl Physiol 106:345–352. https://doi.org/10.1007/s00421-009-1010-0
Cirillo I, Vizzaccaro A, Crimi E (2003) Airway reactivity and diving in healthy and atopic subjects. Med Sci Sports Exerc 35:1493–1498. https://doi.org/10.1249/01.MSS.0000084424.67486.5B
Degryse J, Buffels J, Van Dijck Y et al (2012) Accuracy of office spirometry performed by trained primary-care physicians using the MIR spirobank hand-held spirometer. Respiration 83:543–552. https://doi.org/10.1159/000334907
Dujic Z, Marinovic J, Obad A et al (2011) A no-decompression air dive and ultrasound lung comets. Aviat Space Environ Med 82:40–43
Fahlman A, Dromsky DM (2006) Dehydration effects on the risk of severe decompression sickness in a swine model. Aviat Space Environ Med 77:102–106
Fock AW (2013) Analysis of recreational closed-circuit rebreather deaths 1998–2010. Diving Hyperb Med: J S Pac Underw Med Soc 43:78–85
Fock A, Harris R, Slade M (2013) Oxygen exposure and toxicity in recreational technical divers. Diving Hyperb Med 43:67–71
Gaustad SE, Kondratiev TV, Eftedal I, Tveita T (2020) Continuous hemodynamic monitoring in an intact rat model of simulated diving. Front Physiol 10:1597. https://doi.org/10.3389/fphys.2019.01597
Godfrey MS, Jankowich MD (2016) The vital capacity is vital. Chest 149:238–251. https://doi.org/10.1378/chest.15-1045
Graham BL, Steenbruggen I, Miller MR et al (2019) Standardization of spirometry 2019 update. An official American thoracic society and European respiratory society technical statement. Am J Respir Crit Care Med 200:e70–e88. https://doi.org/10.1164/rccm.201908-1590ST
Hong SK, Claybaugh JR (1989) Hormonal and renal responses to hyperbaria. In: Claybaugh JR, Wade CE (eds) Hormonal regulation of fluid and electrolytes. Springer US, Boston, MA, pp 117–146
Krol K, Morgan MA, Khurana S (2019) Pulmonary function testing and cardiopulmonary exercise testing. Med Clin North Am 103:565–576. https://doi.org/10.1016/j.mcna.2018.12.014
Lafère P, Hemelryck W, Germonpré P et al (2019) Early detection of diving-related cognitive impairment of different nitrogen-oxygen gas mixtures using critical flicker fusion frequency. Diving Hyperb Med 49:119–126. https://doi.org/10.28920/dhm49.2.119-126
Ljubkovic M, Gaustad SE, Marinovic J et al (2010) Ultrasonic evidence of acute interstitial lung edema after SCUBA diving is resolved within 2–3 h. Respir Physiol Neurobiol 171:165–170. https://doi.org/10.1016/j.resp.2010.02.008
Lund, Scheinin K et al (1999) Heart rate variability in healthy volunteers during normobaric and hyperbaric hyperoxia: heart rate variability during hyperoxia. Acta Physiol Scand 167:29–35. https://doi.org/10.1046/j.1365-201x.1999.00581.x
Lundell RV, Räisänen-Sokolowski AK, Wuorimaa TK et al (2020) Diving in the arctic: cold water immersion’s effects on heart rate variability in navy divers. Front Physiol 10:1600. https://doi.org/10.3389/fphys.2019.01600
Lundell RV, Tuominen L, Ojanen T et al (2021) Diving responses in experienced rebreather divers: short-term heart rate variability in cold water diving. Front Physiol 12:649319. https://doi.org/10.3389/fphys.2021.649319
Marinovic J, Ljubkovic M, Obad A et al (2010) Assessment of extravascular lung water and cardiac function in trimix SCUBA diving. Med Sci Sports Exerc 42:1054–1061. https://doi.org/10.1249/MSS.0b013e3181c5b8a8
Mitchell SJ, Doolette DJ (2013) Recreational technical diving part 1: an introduction to technical diving methods and activities. Diving Hyperb Med 43:86–93
Noh Y, Posada-Quintero HF, Bai Y et al (2018) Effect of shallow and deep SCUBA dives on heart rate variability. Front Physiol. https://doi.org/10.3389/fphys.2018.00110
Papadopoulou V, Tang M-X, Balestra C et al (2014) Circulatory bubble dynamics: from physical to biological aspects. Adv Coll Interface Sci 206:239–249. https://doi.org/10.1016/j.cis.2014.01.017
Rocco M, Pelaia P, Di Benedetto P et al (2019) Inert gas narcosis in scuba diving, different gases different reactions. Eur J Appl Physiol 119:247–255. https://doi.org/10.1007/s00421-018-4020-y
Schipke JD, Pelzer M (2001) Effect of immersion, submersion, and scuba diving on heart rate variability. Br J Sports Med 35:174–180. https://doi.org/10.1136/bjsm.35.3.174
Schirato SR, El-Dash I, El-Dash V et al (2018) Heart rate variability changes as an indicator of decompression-related physiological stress. Undersea Hyperb Med 45:173–182
Schirato SR, El-Dash I, El-Dash V et al (2020) Association between heart rate variability and decompression-induced physiological stress. Front Physiol 11:743. https://doi.org/10.3389/fphys.2020.00743
Shykoff BE, Florian JP (2018) Pulmonary effects of repeated six-hour normoxic and hyperoxic dives. PLoS ONE 13:e0202892. https://doi.org/10.1371/journal.pone.0202892
Tetzlaff K, Friege L, Koch A et al (2001) Effects of ambient cold and depth on lung function in humans after a single scuba dive. Eur J Appl Physiol 85:125–129. https://doi.org/10.1007/s004210100421
Vrijdag XC, van Waart H, Sleigh JW et al (2020) Investigating critical flicker fusion frequency for monitoring gas narcosis in divers. Diving Hyperb Med 50:377–385. https://doi.org/10.28920/dhm50.4.377-385
Wilson A (2011) Prevalence and characteristics of lung function changes in recreational scuba divers. Prim Care Respir J 20:59–63. https://doi.org/10.4104/pcrj.2010.00063
Acknowledgements
Authors wish to thank the Under The Pole team for providing and organizing the research facilities. Furthermore, the Gombessa 5 team is also duly acknowledged for sharing scientific data gathered during “Planète Méditerranée” Gombessa 5 expedition.
Funding
The work was supported by grant JGP0RV025 Capsule from Tek Diving SAS.
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ED, EG, FG conceived and designed the UTP3 research. ED, EG conducted UTP3 measurements. CB designed and conducted the Gombessa 5 research. ED, FG, EL analyzed data. ED, CB, EG, EL and FG wrote the manuscript. All authors read and approved the manuscript.
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Conflict of interest
ED is the president of Tek Diving s.a.s., a R&D company dedicated to the development of safety procedures for diving. At the time of the study, EG was in charge of the medical survey of Under The Pole divers.
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All participants were informed of the measurements objectives, procedures, potential risks, discomforts and benefits associated with their involvement. Informed consent was obtained from all individual participants included in the study.
Ethical approval
The study was conducted during working dives performed by the Under The Pole (UTP) 3 team in the frame of the medical survey of divers participating to the Deep Hope scientific program. It was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Communicated by Guido Ferrati.
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Dugrenot, E., Balestra, C., Gouin, E. et al. Physiological effects of mixed-gas deep sea dives using a closed-circuit rebreather: a field pilot study. Eur J Appl Physiol 121, 3323–3331 (2021). https://doi.org/10.1007/s00421-021-04798-y
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DOI: https://doi.org/10.1007/s00421-021-04798-y