Oxygen Toxicity: From Cough to Convulsion

  • Marlon A. Medford
  • Claude A. PiantadosiEmail author
Part of the Oxidative Stress in Applied Basic Research and Clinical Practice book series (OXISTRESS)


Oxygen is by its chemical nature a toxic molecule and organisms that survive in its presence have evolved potent antioxidant defenses. Through basic and clinical research we have come to understand many of the mechanisms of oxygen (O2) toxicity as well as measures that mitigate its risks. When the partial pressure of oxygen (PO2) is increased in the cell, the formation of reactive oxygen species (ROS) is enhanced at multiple locations, such as in the mitochondria. ROS attack biological macromolecules, which disrupts homeostasis and causes tissue and organ system dysfunction that will ultimately be lethal. An oxygen partial pressure (PO2) of 0.21 to 1.0 atm absolute (ATA) is in the normobaric range while a PO2 above 1.0 ATA is termed hyperbaric hyperoxia. As the PO2 in the normobaric range increases, specific physiological disturbances, such as disordered pulmonary gas exchange and retinopathy of prematurity appear, while others occur exclusively at hyperbaric pressures such as peripheral visual loss, seizures, and neurogenic pulmonary injury. Ultimately, the utility of O2 is limited by this toxicity and its therapeutic applications in medicine, aeronautics, and diving must be counterbalanced by the risk of harm.


Hyperbaric Normobaric Hyperoxia Oxygen toxicity Hyperoxic myopia Seizure Nitric oxide Neurogenic pulmonary edema 


  1. 1.
    Dyall SD, Brown MT, Johnson PJ (2004) Ancient invasions: from endosymbionts to organelles. Science 304(5668):253–257PubMedCrossRefGoogle Scholar
  2. 2.
    Babcock GT (1999) How oxygen is activated and reduced in respiration. Proc Natl Acad Sci U S A 96(23):12971–12973PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Fridovich I (1998) Oxygen toxicity: a radical explanation. J Exp Biol 201(Pt 8):1203–1209PubMedGoogle Scholar
  4. 4.
    Piantadosi CA (2003) The biology of human survival: life and death in extreme environments. Oxford University Press, Oxford/New York, xiv, 263 pGoogle Scholar
  5. 5.
    Halliwell B, Gutteridge JMC (2007) Free radicals in biology and medicine, 4th edn. Oxford University Press, Oxford/New York, xxxvi, 851 p., 8 p. of platesGoogle Scholar
  6. 6.
    Gerschman R et al (1954) Oxygen poisoning and X-irradiation: a mechanism in common. 1954. Nutrition 17(2):162Google Scholar
  7. 7.
    Yamaguchi KT et al (1992) Measurement of free radicals from smoke inhalation and oxygen exposure by spin trapping and ESR spectroscopy. Free Radic Res Commun 16(3):167–174PubMedCrossRefGoogle Scholar
  8. 8.
    Narkowicz CK, Vial JH, McCartney PW (1993) Hyperbaric oxygen therapy increases free radical levels in the blood of humans. Free Radic Res Commun 19(2):71–80PubMedCrossRefGoogle Scholar
  9. 9.
    Halliwell B, Aruoma OI (1991) DNA damage by oxygen-derived species. Its mechanism and measurement in mammalian systems. FEBS Lett 281(1–2):9–19PubMedCrossRefGoogle Scholar
  10. 10.
    Wiseman H, Halliwell B (1996) Damage to DNA by reactive oxygen and nitrogen species: role in inflammatory disease and progression to cancer. Biochem J 313(Pt 1):17–29PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Dennog C et al (1996) Detection of DNA damage after hyperbaric oxygen (HBO) therapy. Mutagenesis 11(6):605–609PubMedCrossRefGoogle Scholar
  12. 12.
    Rothfuss A, Dennog C, Speit G (1998) Adaptive protection against the induction of oxidative DNA damage after hyperbaric oxygen treatment. Carcinogenesis 19(11):1913–1917PubMedCrossRefGoogle Scholar
  13. 13.
    Speit G, Dennog C, Lampl L (1998) Biological significance of DNA damage induced by hyperbaric oxygen. Mutagenesis 13(1):85–87PubMedCrossRefGoogle Scholar
  14. 14.
    Feldmeier J et al (2003) Hyperbaric oxygen: does it promote growth or recurrence of malignancy? Undersea Hyperb Med 30(1):1–18PubMedGoogle Scholar
  15. 15.
    Zaleska MM, Floyd RA (1985) Regional lipid peroxidation in rat brain in vitro: possible role of endogenous iron. Neurochem Res 10(3):397–410PubMedCrossRefGoogle Scholar
  16. 16.
    Arai H et al (1987) Importance of two iron-reducing systems in lipid peroxidation of rat brain: implications for oxygen toxicity in the central nervous system. Biochem Int 14(4):741–749PubMedGoogle Scholar
  17. 17.
    Freeman BA, Crapo JD (1982) Biology of disease: free radicals and tissue injury. Laboratory investigation 47(5):412–426PubMedGoogle Scholar
  18. 18.
    Ara J et al (1998) Inactivation of tyrosine hydroxylase by nitration following exposure to peroxynitrite and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Proc Natl Acad Sci U S A 95(13):7659–7663PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Haugaard N (1946) Oxygen poisoning; the relation between inactivation of enzymes by oxygen and essential sulfhydryl groups. J Biol Chem 164:265–270PubMedGoogle Scholar
  20. 20.
    Jamieson D, Van Den Brenk HA (1962) Pulmonary damage due to high pressure oxygen breathing in rats. 2. Changes in dehydrogenase activity of rat lung. Aust J Exp Biol Med Sci 40:51–56PubMedCrossRefGoogle Scholar
  21. 21.
    Jamieson D, Ladner K, Vandenbrenk HA (1963) Pulmonary damage due to high pressure oxygen breathing in rats. 4. Quantitative analysis of sulphydryl and disulphide groups in rat lungs. Aust J Exp Biol Med Sci 41:491–497PubMedCrossRefGoogle Scholar
  22. 22.
    Kovachich GB, Mishra OP (1981) Partial inactivation of Na, K-ATPase in cortical brain slices incubated in normal Krebs-Ringer phosphate medium at 1 and at 10 atm oxygen pressures. J Neurochem 36(1):333–335PubMedCrossRefGoogle Scholar
  23. 23.
    Kovachich GB, Mishra OP, Clark JM (1981) Depression of cortical Na+, K + -ATPase activity in rats exposed to hyperbaric oxygen. Brain Res 206(1):229–232PubMedCrossRefGoogle Scholar
  24. 24.
    Bennett PB, Elliott DH (1982) The Physiology and medicine of diving, 3rd edn. Baillière Tindall, London/Carson, California, published in the U.S.A. and Canada by Best Pub. x, 570 pGoogle Scholar
  25. 25.
    Reznikov K et al (2000) Clustering of apoptotic cells via bystander killing by peroxides. FASEB J 14(12):1754–1764PubMedCrossRefGoogle Scholar
  26. 26.
    Bratton DL, Henson PM (2005) Autoimmunity and apoptosis: refusing to go quietly. Nat Med 11(1):26–27PubMedCrossRefGoogle Scholar
  27. 27.
    Hampton MB, Morgan PE, Davies MJ (2002) Inactivation of cellular caspases by peptide-derived tryptophan and tyrosine peroxides. FEBS Lett 527(1–3):289–292PubMedCrossRefGoogle Scholar
  28. 28.
    Barazzone C et al (1998) Oxygen toxicity in mouse lung: pathways to cell death. Am J Respir Cell Mol Biol 19(4):573–581PubMedCrossRefGoogle Scholar
  29. 29.
    Tierney DF, Ayers L, Kasuyama RS (1977) Altered sensitivity to oxygen toxicity. Am Rev Respir Dis 115(6 Pt 2):59–65PubMedGoogle Scholar
  30. 30.
    Gregory EM, Fridovich I (1973) Induction of superoxide dismutase by molecular oxygen. J Bacteriol 114(2):543–548PubMedCentralPubMedGoogle Scholar
  31. 31.
    Asikainen TM et al (2002) Increased sensitivity of homozygous Sod2 mutant mice to oxygen toxicity. Free Radic Biol Med 32(2):175–186PubMedCrossRefGoogle Scholar
  32. 32.
    Tsan MF (2001) Superoxide dismutase and pulmonary oxygen toxicity: lessons from transgenic and knockout mice (Review). Int J Mol Med 7(1):13–19PubMedGoogle Scholar
  33. 33.
    Welty-Wolf KE et al (1997) Aerosolized manganese SOD decreases hyperoxic pulmonary injury in primates. II. Morphometric analysis. J Appl Physiol 83(2):559–568PubMedGoogle Scholar
  34. 34.
    Athale J et al (2012) Nrf2 promotes alveolar mitochondrial biogenesis and resolution of lung injury in Staphylococcus aureus pneumonia in mice. Free Radic Biol Med 53(8):1584–1594PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Nishiki K et al (1976) Oxygen toxicity in the perfused rat liver and lung under hyperbaric conditions. Biochem J 160(2):343–355PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Allen JE et al (1973) Studies on the biochemical basis of oxygen toxicity. Biochim Biophys Acta 320(3):708–728PubMedCrossRefGoogle Scholar
  37. 37.
    Fridovich I, Freeman B (1986) Antioxidant defenses in the lung. Annu Rev Physiol 48:693–702PubMedCrossRefGoogle Scholar
  38. 38.
    Stone WL et al (1989) The role of antioxidant nutrients in preventing hyperbaric oxygen damage to the retina. Free Radic Biol Med 6(5):505–512PubMedCrossRefGoogle Scholar
  39. 39.
    Kaikkonen J et al (2001) Supplementation with vitamin E but not with vitamin C lowers lipid peroxidation in vivo in mildly hypercholesterolemic men. Free Radic Res 35(6):967–978PubMedCrossRefGoogle Scholar
  40. 40.
    Boadi WY et al (1991) Effects of dietary supplementation with vitamin E, riboflavin and selenium on central nervous system oxygen toxicity. Pharmacol Toxicol 68(2):77–82PubMedCrossRefGoogle Scholar
  41. 41.
    Clark JM, Lambertsen CJ (1971) Rate of development of pulmonary O2 toxicity in man during O2 breathing at 2.0 Ata. J Appl Physiol 30(5):739–752PubMedGoogle Scholar
  42. 42.
    Clark JM, Lambertsen CJ (1971) Pulmonary oxygen toxicity: a review. Pharmacol Rev 23(2):37–133PubMedGoogle Scholar
  43. 43.
    Bitterman H (2009) Bench-to-bedside review: oxygen as a drug. Crit Care 13(1):205PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Januszkiewicz AJ, Faiman MD (1984) The effect of in vivo hyperoxic exposure on the release of endogenous histamine from the rat isolated perfused lung. Toxicol Appl Pharmacol 72(1):134–141PubMedCrossRefGoogle Scholar
  45. 45.
    Webster NR, Toothill C, Cowen PN (1987) Tissue responses to hyperoxia. Biochemistry and pathology. Br J Anaesth 59(6):760–771PubMedCrossRefGoogle Scholar
  46. 46.
    Narasaraju TA et al (2003) Protein nitration in rat lungs during hyperoxia exposure: a possible role of myeloperoxidase. Am J Physiol Lung Cell Mol Physiol 285(5):L1037–L1045PubMedCrossRefGoogle Scholar
  47. 47.
    Cross CE et al (1994) Oxidants, antioxidants, and respiratory tract lining fluids. Environ Health Perspect 102(Suppl 10):185–191PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Caldwell PR et al (1966) Changes in lung volume, diffusing capacity, and blood gases in men breathing oxygen. J Appl Physiol 21(5):1477–1483PubMedGoogle Scholar
  49. 49.
    Clark JM et al (1999) Effects of prolonged oxygen exposure at 1.5, 2.0, or 2.5 ATA on pulmonary function in men (predictive studies V). J Appl Physiol 86(1):243–259PubMedGoogle Scholar
  50. 50.
    Thorsen E, Aanderud L, Aasen TB (1998) Effects of a standard hyperbaric oxygen treatment protocol on pulmonary function. Eur Respir J 12(6):1442–1445PubMedCrossRefGoogle Scholar
  51. 51.
    Suzuki S, Ikeda T, Hashimoto A (1991) Decrease in the single-breath diffusing capacity after saturation dives. Undersea Biomed Res 18(2):103–109PubMedGoogle Scholar
  52. 52.
    Demchenko IT et al (2007) Similar but not the same: normobaric and hyperbaric pulmonary oxygen toxicity, the role of nitric oxide. Am J Physiol Lung Cell Mol Physiol 293(1):L229–L238PubMedCrossRefGoogle Scholar
  53. 53.
    Clark JM (2004) Extension of oxygen tolerance by interrupted exposure. Undersea Hyperb Med 31(2):195–198PubMedGoogle Scholar
  54. 54.
    Donald KW (1947) Oxygen poisoning in man. Br Med J 1(4506):667, passimPubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Bitterman N (2004) CNS oxygen toxicity. Undersea Hyperb Med 31(1):63–72PubMedGoogle Scholar
  56. 56.
    Butler FK Jr, Thalmann ED (1986) Central nervous system oxygen toxicity in closed circuit scuba divers II. Undersea Biomed Res 13(2):193–223PubMedGoogle Scholar
  57. 57.
    Arieli R (1998) Latency of oxygen toxicity of the central nervous system in rats as a function of carbon dioxide production and partial pressure of oxygen. Eur J Appl Physiol Occup Physiol 78(5):454–459PubMedCrossRefGoogle Scholar
  58. 58.
    Kety SS, Schmidt CF (1948) The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men. J Clin Invest 27(4):484–492PubMedCentralPubMedCrossRefGoogle Scholar
  59. 59.
    Reivich M (1969) Regulation of the cerebral circulation. Clin Neurosurg 16:378–418PubMedGoogle Scholar
  60. 60.
    Lambertsen CJ et al (1955) Oxygen toxicity; arterial and internal jugular blood gas composition in man during inhalation of air, 100 % O2 and 2 % CO2 in O2 at 3.5 atmospheres ambient pressure. J Appl Physiol 8(3):255–263PubMedGoogle Scholar
  61. 61.
    Raichle ME, Stone HL (1971) Cerebral blood flow autoregulation and graded hypercapnia. Eur Neurol 6(1):1–5PubMedCrossRefGoogle Scholar
  62. 62.
    Raichle ME, Plum F (1972) Hyperventilation and cerebral blood flow. Stroke 3(5):566–575PubMedCrossRefGoogle Scholar
  63. 63.
    Stone HL, Raichle ME, Hernandez M (1974) The effect of sympathetic denervation on cerebral CO2 sensitivity. Stroke 5(1):13–18PubMedCrossRefGoogle Scholar
  64. 64.
    Matalon S et al (2003) Regulation of ion channel structure and function by reactive oxygen-nitrogen species. Am J Physiol Lung Cell Mol Physiol 285(6):L1184–L1189PubMedCrossRefGoogle Scholar
  65. 65.
    Andreoli SP et al (1993) Oxidant-induced alterations in glucose and phosphate transport in LLC-PK1 cells: mechanisms of injury. Am J Physiol 265(3 Pt 2):F377–F384PubMedGoogle Scholar
  66. 66.
    Tunnicliff G, Urton M, Wood JD (1973) Susceptibility of chick brain L-glutamic acid decarboxylase and other neurotransmitter enzymes to hyperbaric oxygen in vitro. Biochem Pharmacol 22(4):501–505PubMedCrossRefGoogle Scholar
  67. 67.
    Davis K et al (2001) Oxygen-induced seizures and inhibition of human glutamate decarboxylase and porcine cysteine sulfinic acid decarboxylase by oxygen and nitric oxide. J Biomed Sci 8(4):359–364PubMedCrossRefGoogle Scholar
  68. 68.
    Wood JD, Watson WJ (1963) Gamma-aminobutyric acid levels in the brain of rats exposed to oxygen at high pressures. Can J Biochem Physiol 41:1907–1913PubMedCrossRefGoogle Scholar
  69. 69.
    Wood JD, Watson WJ (1969) The effect of hyperoxia and hypoxia on free and bound gamma-aminobutyric acid in mammalian brain. Can J Biochem 47(10):994–997PubMedCrossRefGoogle Scholar
  70. 70.
    Alderman JL, Culver BW, Shellenberger MK (1974) An examination of the role of gamma-aminobutyric acid (GABA) in hyperbaric oxygen-induced convulsions in the rat. I. Effects of increased gamma-aminobutyric acid and protective agents. J Pharmacol Exp Ther 190(2):334–340PubMedGoogle Scholar
  71. 71.
    Faiman MD et al (1977) A rapid and simple radioactive method for the determination of disulfiram and its metabolites from a single sample of biological fluid or tissue. Res Commun Chem Pathol Pharmacol 17(3):481–496PubMedGoogle Scholar
  72. 72.
    Wood JD (1975) The role of gamma-aminobutyric acid in the mechanism of seizures. Prog Neurobiol 5(1):77–95PubMedCrossRefGoogle Scholar
  73. 73.
    Colton CA, Colton JS (1985) Blockade of hyperbaric oxygen induced seizures by excitatory amino acid antagonists. Can J Physiol Pharmacol 63(5):519–521PubMedCrossRefGoogle Scholar
  74. 74.
    Radomski MW, Watson WJ (1973) Effect of lithium on acute oxygen toxicity and associated changes in brain gamma-aminobutyric acid. Aerosp Med 44(4):387–392PubMedGoogle Scholar
  75. 75.
    Demchenko IT et al (2012) Nitric oxide-mediated central sympathetic excitation promotes CNS and pulmonary O(2) toxicity. J Appl Physiol 112(11):1814–1823PubMedCentralPubMedCrossRefGoogle Scholar
  76. 76.
    Bitterman N, Bitterman H (1998) L-arginine-NO pathway and CNS oxygen toxicity. J Appl Physiol 84(5):1633–1638PubMedGoogle Scholar
  77. 77.
    Hagioka S et al (2005) Effects of 7-nitroindazole and N-nitro-l-arginine methyl ester on changes in cerebral blood flow and nitric oxide production preceding development of hyperbaric oxygen-induced seizures in rats. Neurosci Lett 382(3):206–210PubMedCrossRefGoogle Scholar
  78. 78.
    Sato T et al (2001) Changes in nitric oxide production and cerebral blood flow before development of hyperbaric oxygen-induced seizures in rats. Brain Res 918(1–2):131–140PubMedCrossRefGoogle Scholar
  79. 79.
    Rees DD, Palmer RM, Moncada S (1989) Role of endothelium-derived nitric oxide in the regulation of blood pressure. Proc Natl Acad Sci U S A 86(9):3375–3378PubMedCentralPubMedCrossRefGoogle Scholar
  80. 80.
    Le Cras TD, McMurtry IF (2001) Nitric oxide production in the hypoxic lung. Am J Physiol Lung Cell Mol Physiol 280(4):L575–L582PubMedGoogle Scholar
  81. 81.
    Rengasamy A, Johns RA (1996) Determination of Km for oxygen of nitric oxide synthase isoforms. J Pharmacol Exp Ther 276(1):30–33PubMedGoogle Scholar
  82. 82.
    Mitchell SJ et al (2012) Recommendations for rescue of a submerged unresponsive compressed-gas diver. Undersea Hyperb Med 39(6):1099–1108PubMedGoogle Scholar
  83. 83.
    Diving, U.S.N.S.o., U.S. Navy Diving Manual, in Naval Sea Systems Command, 2008, U.S. Naval Sea Systems Command. p. 44Google Scholar
  84. 84.
    Klaeger C et al (1996) An elevated level of copper zinc superoxide dismutase fails to prevent oxygen induced retinopathy in mice. Br J Ophthalmol 80(5):429–434PubMedCentralPubMedCrossRefGoogle Scholar
  85. 85.
    James S, Lanman JT (1976) History of oxygen therapy and retrolental fibroplasia. Prepared by the American Academy of Pediatrics, Committee on Fetus and Newborn with the collaboration of special consultants. Pediatrics 57(suppl 2):591–642PubMedGoogle Scholar
  86. 86.
    Lyne AJ (1978) Ocular effects of hyperbaric oxygen. Trans Ophthalmol Soc U K 98(1):66–68PubMedGoogle Scholar
  87. 87.
    Anderson B Jr, Farmer JC Jr (1978) Hyperoxic myopia. Trans Am Ophthalmol Soc 76:116–124PubMedCentralPubMedGoogle Scholar
  88. 88.
    Heald K, Langham ME (1956) Permeability of the cornea and the blood-aqueous barrier to oxygen. Br J Ophthalmol 40(12):705–720PubMedCentralPubMedCrossRefGoogle Scholar
  89. 89.
    Evanger K et al (2004) Ocular refractive changes in patients receiving hyperbaric oxygen administered by oronasal mask or hood. Acta Ophthalmol Scand 82(4):449–453PubMedCrossRefGoogle Scholar
  90. 90.
    Bloemendal H et al (2004) Ageing and vision: structure, stability and function of lens crystallins. Prog Biophys Mol Biol 86(3):407–485PubMedCrossRefGoogle Scholar
  91. 91.
    Ma W et al (2004) The effect of stress withdrawal on gene expression and certain biochemical and cell biological properties of peroxide-conditioned cell lines. FASEB J 18(3):480–488PubMedCrossRefGoogle Scholar
  92. 92.
    Spector A (1995) Oxidative stress-induced cataract: mechanism of action. FASEB J 9(12):1173–1182PubMedGoogle Scholar
  93. 93.
    Palmquist BM, Philipson B, Barr PO (1984) Nuclear cataract and myopia during hyperbaric oxygen therapy. Br J Ophthalmol 68(2):113–117PubMedCentralPubMedCrossRefGoogle Scholar
  94. 94.
    Schaal S et al (2003) Lenticular oxygen toxicity. Invest Ophthalmol Vis Sci 44(8):3476–3484PubMedCrossRefGoogle Scholar
  95. 95.
    Behnke AR, Johnson FS, Poppen JR, Motley EP (1935) The effect of oxygen on man at pressures from 1 to 4 atmospheres. Am J Physiol 110:565–572Google Scholar
  96. 96.
    Rosenberg E, Shibata HR, MacLean LD (1966) Blood gas and neurological responses to inhalation of oxygen at 3 atmospheres. Proc Soc Exp Biol Med 122(2):313–317PubMedCrossRefGoogle Scholar
  97. 97.
    Nichols CW, Lambertsen C (1969) Effects of high oxygen pressures on the eye. N Engl J Med 281(1):25–30PubMedCrossRefGoogle Scholar
  98. 98.
    Dise CA et al (1985) Normobaric hyperoxia in vivo inhibits fatty acid incorporation into sheep erythrocyte phospholipid in vitro. J Lab Clin Med 105(1):89–93PubMedGoogle Scholar
  99. 99.
    Mengel CE, Kann HE Jr (1966) Effects of in vivo hyperoxia on erythrocytes. 3. In vivo peroxidation of erythrocyte lipid. J Clin Invest 45(7):1150–1158PubMedCentralPubMedCrossRefGoogle Scholar
  100. 100.
    Mengel CE et al (1965) Effects of in vivo hyperoxia on erythrocytes. II. Hemolysis in a human after exposure to oxygen under high pressure. Blood 25:822–829PubMedGoogle Scholar
  101. 101.
    Mengel CE et al (1964) Effects of in vivo hyperoxia on erythrocytes. 1. Hemolysis in mice exposed to hyperbaric oxygenation. Proc Soc Exp Biol Med 116:259–261PubMedCrossRefGoogle Scholar
  102. 102.
    Dise CA et al (1987) Hyperbaric hyperoxia reversibly inhibits erythrocyte phospholipid fatty acid turnover. J Appl Physiol 62(2):533–538PubMedGoogle Scholar
  103. 103.
    Lambertsen CJ, Gelfand R, Pisarello JB, Cobbs WH, Bevilacqua JE, Schwartz DM, Montabana DJ, Leach CS, Johnson PC, Fletcher DE (1987) Definition of tolerance to continuous hyperoxia in man. An abstract report of Predictive Studies V. In: Bove AA, Greenbaum LJ (eds) Underwater and hyperbaric physiology IX, Undersea and Hyperbaric Medical Society, Bethesda, MD, pp 717–735Google Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Anesthesiology, Center for Hyperbaric Medicine and Environmental PhysiologyDuke University Medical CenterDurhamUSA
  2. 2.Department of Medicine, Center for Hyperbaric Medicine and Environmental PhysiologyDuke University Medical CenterDurhamUSA

Personalised recommendations