European Journal of Applied Physiology

, Volume 106, Issue 5, pp 691–695

Effect of in-water recompression with oxygen to 6 msw versus normobaric oxygen breathing on bubble formation in divers

Original Article

Abstract

It is generally accepted that the incidence of decompression sickness (DCS) from hyperbaric exposures is low when few or no bubbles are present in the circulation. To date, no data are available on the influence of in-water oxygen breathing on bubble formation following a provocative dive in man. The purpose of this study was to compare the effect of post-dive hyperbaric versus normobaric oxygen breathing (NOB) on venous circulating bubbles. Nineteen divers carried out open-sea field air dives at 30 msw depth for 30 min followed by a 9 min stop at 3 msw. Each diver performed three dives: one control dive, and two dives followed by 30 min of hyperbaric oxygen breathing (HOB) or NOB; both HOB and NOB started 10 min after surfacing. For HOB, divers were recompressed in-water to 6 msw at rest, whereas NOB was performed in a dry room in supine position. Decompression bubbles were examined by a precordial pulsed Doppler. Bubble count was significantly lower for post-dive NOB than for control dives. HOB dramatically suppressed circulating bubble formation with a bubble count significantly lower than for NOB or controls. In-water recompression with oxygen to 6 msw is more effective in removing gas bubbles than NOB. This treatment could be used in situations of “interrupted” or “omitted” decompression, where a diver returns to the water in order to complete decompression prior to the onset of symptoms. Further investigations are needed before to recommend this protocol as an emergency treatment for DCS.

Keywords

Diving Decompression sickness Bubble In-water recompression 

References

  1. Aharon-Peretz J, Adir Y, Gordon CR, Kol S, Gal N, Melamed Y (1993) Spinal cord decompression sickness in sport diving. Arch Neurol 50:753–756PubMedGoogle Scholar
  2. Anderson D, Nagasawa G, Norfleet W, Olszowka A, Lundgren C (1991) O2 pressures between 0.12 and 2.5 atm abs, circulatory function, and N2 elimination. Undersea Biomed Res 18(4):279–292PubMedGoogle Scholar
  3. Ball R (1993) Effect of severity, time to recompression with oxygen, and re-treatment on outcome in forty-nine cases of spinal cord decompression sickness. Undersea Hyperb Med 20(2):133–145PubMedGoogle Scholar
  4. Balldin UI (1973) Effects of ambient temperature and body position on tissue nitrogen elimination in man. Aerosp Med 44:365–370PubMedGoogle Scholar
  5. Balldin UI, Lundgren CEG (1972) Effects of immersion with the head above the water on tissue nitrogen elimination in man. Aerosp Med 43:1101–1108PubMedGoogle Scholar
  6. Bert P (1878) La Pression barométrique. Recherches de physiologie expérimentale, Masson, ParisGoogle Scholar
  7. Blatteau JE, Souraud JB, Gempp E, Boussuges A (2006a) Gas nuclei, their origin, and their role in bubble formation. Aviat Space Environ Med 77:1068–1076PubMedGoogle Scholar
  8. Blatteau JE, Jean F, Pontier JM, Blanche E, Bompar JM, Meaudre E, Etienne JL (2006) Decompression sickness accident management in remote areas. Use of immediate in-water recompression therapy. Review and elaboration of a new protocol targeted for a mission at Clipperton atoll. Ann Fr Anesth Reanim 25(8):874–883. doi:10.1016/j.annfar.2006.04.007
  9. Brubakk A (2004) Hyperbaric oxygen therapy: oxygen and bubbles. Undersea Hyperb Med 31(1):73–79PubMedGoogle Scholar
  10. Edmonds C (1999) Australian underwater oxygen treatment of DCS. In: Key E and Spencer MP (eds) In-water recompression. Proceedings for the 48th workshop of the Undersea and Hyperbaric Medical Society, pp 2–15Google Scholar
  11. Francis TJR, Mitchell SJ (2003) Pathophysiology of decompression sickness. In: Brubbak AO, Neuman TS (eds) The Bennett and Elliot’s physiology and medicine of diving, 5th edn. WB Saunders, London, pp 530–556Google Scholar
  12. Moon RE, Gorman DF (2003) Treatment of the decompression disorders. In: Brubbak AO, Neuman TS (eds) The Bennett and Elliot’s physiology and medicine of diving, 5th edn. WB Saunders, London, pp 600–650Google Scholar
  13. Nishi RY, Brubakk AO, Eftedal OS (2003) Bubble detection. In: Brubakk AO, Neuman TS (eds) Bennett and Elliot’s physiology and medicine of diving, 5th edn. WB Saunders, London, pp 501–529Google Scholar
  14. Nossum V, Koteng S, Brubakk A (1999) Endothelial damage by bubbles in the pulmonary artery of the pig. Undersea Hyperb Med 26(1):1–8PubMedGoogle Scholar
  15. Nossum V, Hjelde A, Brubakk A (2002) Small amounts of venous gas embolism cause delayed impairment of endothelial function and increase polymorphonuclear neutrophil inflammation. Eur J Appl Physiol 86:209–214. doi:10.1007/s00421-001-0531-y PubMedCrossRefGoogle Scholar
  16. Pyle RL (1999). Keeping up with the times: application of technical diving practices for in-water recompression. In: Key E, Spencer MP (eds) In-water recompression. Proceedings for the 48th workshop of the undersea and hyperbaric medical society, pp 74–88Google Scholar
  17. Ross JAS, Trevett AJ, Forbes RF, Rae CK, Sheehan C (2004) The treatment of decompression illness arising from diving around the Orkeny islands October 1991–June 2003. Undersea Hyperb Med 31(3):354Google Scholar
  18. Spencer MP (1976) Decompression limits for compressed air determined by ultrasonically detected blood bubbles. J Appl Physiol 40:229–235PubMedGoogle Scholar
  19. Stipp W (2004) The influence of time to hyperbaric oxygen treatment on the outcome of neurological decompression illness in divers. Undersea Hyperb Med 31(3):353Google Scholar
  20. Mollerlokken A, Nossum V, Hovin W, Gennser M, Brubakk A (2007) Recompression with oxygen to 160 kPa eliminates vascular bubbles, but does not prevent endothelium damage. Eur J Underwater Hyperbaric Med 8(1, 2):11–16Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Ecole de Plongée Marine NationaleToulon ArméesFrance
  2. 2.Département de MédecineHyperbare Hôpital d’Instruction des Armées Sainte-AnneToulon ArméesFrance

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