High incidence of venous and arterial gas emboli at rest after trimix diving without protocol violations

Journal of Applied Physiology

Volumn 109, Issue 6, 2010, Pages 1670-1674

  Ljubkovic, Marko ^a   Marinovic, Jasna ^a   Obad, Ante ^a   Breskovic, Toni ^a   Gaustad, Svein E ^b   Dujic, Zeljko ^a  

^a UNIVERSITY OF SPLIT   (Croatia)

^b NORWEGIAN UNIVERSITY OF SCIENCE AND TECHNOLOGY   (Norway)

Author keywords

Bubble detection; Left ventricular gas emboli; Pulmonary artery pressure; Technical diving

Indexed keywords

HELIUM; NITROGEN; OXYGEN; TRIMIX;

ADULT; AIR EMBOLISM; ARTICLE; BLOOD PRESSURE; DIVING; DOPPLER ECHOCARDIOGRAPHY; ECHOGRAPHY; HUMAN; INCIDENCE; INHALATIONAL DRUG ADMINISTRATION; MALE; MIDDLE AGED; PATENT FORAMEN OVALE; PATHOPHYSIOLOGY; PULMONARY ARTERY; TIME; VEIN;

ADMINISTRATION, INHALATION; ADULT; BLOOD PRESSURE; DIVING; ECHOCARDIOGRAPHY, DOPPLER, COLOR; ECHOCARDIOGRAPHY, DOPPLER, PULSED; EMBOLISM, AIR; FORAMEN OVALE, PATENT; HELIUM; HUMANS; INCIDENCE; MALE; MIDDLE AGED; NITROGEN; OXYGEN; PULMONARY ARTERY; TIME FACTORS; VEINS;

EID: 78651287521     PISSN: 87507587     EISSN: 15221601     Source Type: Journal    
DOI: 10.1152/japplphysiol.01369.2009     Document Type: Article

References (48)

1. Bakovic D, Glavas D, Palada I, Breskovic T, Fabijanic D, Obad A, Valic Z, Brubakk AO, Dujic Z. High-grade bubbles in left and right heart in an asymptomatic diver at rest after surfacing. Aviat Space Environ Med 79:626-628, 2008.
2. Bayne CG, Hunt WS, Johanson DC, Flynn ET, Weathersby PK. Doppler bubble detection and decompression sickness: a prospective clinical trial. Undersea Biomed Res 12:327-332, 1985.
3. Bonin B, Straub PW, Schibli R, Buhlmann AA. Blood coagulation during critical decompression following diving experiments with oxygen-helium. Aerospace Med 44:508-512, 1973.
4. Brubakk AO, Duplancic D, Valic Z, Palada I, Obad A, Bakovic D, Wisloff U, Dujic Z. A single air dive reduces arterial endothelial function in man. J Physiol 566:901-906, 2005.
5. Brubakk AO, Neuman TS. (Eds.) Bennett and Elliott's Physiology and Medicine of Diving (5th ed.). London: Saunders, 2003.
6. Brubakk AO, Peterson R, Grip A, Holand B, Onarheim J, Segadal K, Kunkle TD, Tonjum S. Gas bubbles in the circulation of divers after ascending excursions from 300 to 250 msw. J Appl Physiol 60:45-51, 1986.
7. Butler BD, Hills BA. The lung as a filter for microbubbles. J Appl Physiol 47:537-543, 1979.
8. Butler BD, Robinson R, Little T, Chelly JE, Doursout MF. Cardiopul-monary changes with moderate decompression in rats. Undersea Hyperb Med 23:83-89, 1996.
9. Chang HK, Delaunois L, Boileau R, Martin RR. Redistribution of pulmonary blood flow during experimental air embolism. J Appl Physiol 51:211-217, 1981.
10. Divers Alert Network. Report on Decompression Illness and Diving Fatalities, 2003. Durham, NC: DAN, 2003.
11. Dujic Z, Duplancic D, Marinovic-Terzic I, Bakovic D, Ivancev V, Valic Z, Eterovic D, Petri NM, Wisloff U, Brubakk AO. Aerobic exercise before diving reduces venous gas bubble formation in humans. J Physiol 555:637-642, 2004.
12. Dujic Z, Obad A, Palada I, Ivancev V, Valic Z. Venous bubble count declines during strenuous exercise after an open sea dive to 30 m. Aviat Space Environ Med 77:592-596, 2006.
13. Dujic Z, Obad A, Palada I, Valic Z, Brubakk AO. A single open sea air dive increases pulmonary artery pressure and reduces right ventricular function in professional divers. Eur J Appl Physiol 97:478-485, 2006.
14. Dujic Z, Palada I, Obad A, Duplancic D, Bakovic D, Valic Z. Exercise during a 3-min decompression stop reduces postdive venous gas bubbles. Med Sci Sports Exerc 37:1319-1323, 2005.
15. Dujic Z, Palada I, Obad A, Duplancic D, Brubakk AO, Valic Z. Exercise-induced intrapulmonary shunting of venous gas emboli does not occur after open-sea diving. J Appl Physiol 99:944-949, 2005.
16. Eftedal O, Brubakk AO. Agreement between trained and untrained observers in grading intravascular bubble signals in ultrasonic images. Undersea Hyperb Med 24:293-299, 1997.
17. Eftedal O, Brubakk AO, Nishi RY. Ultrasonic evaluation of decompression: the relationship between bubble grades and bubble numbers. Undersea Hyperb Med 25:35-36, 1998.
18. Eftedal OS, Lydersen S, Brubakk AO. The relationship between venous gas bubbles and adverse effects of decompression after air dives. Undersea Hyperb Med 34:99-105, 2007.
19. Eldridge MW, Dempsey JA, Haverkamp HC, Lovering AT, Hokan-son JS. Exercise-induced intrapulmonary arteriovenous shunting in healthy humans. J Appl Physiol 97:797-805, 2004.
20. Garrett JL. The role of patent foramen ovale in altitude-induced decompression sickness. In: Hypobaric Decompression Sickness: Proceedings of a Workshop held at Armstrong Laboratory, Brooks AFB, TX, 16-18 October 1990, edited by Pilmanis AA. Alexandria, VA: Aerospace Medical Association and Undersea and Hyperbaric Medical Society, 1995, p. 81-96.
21. Gerriets T, Tetzlaff K, Liceni T, Schafer C, Rosengarten B, Kopiske G, Algermissen C, Struck N, Kaps M. Arteriovenous bubbles following cold water sport dives: relation to right-to-left shunting. Neurology 55:1741-1743, 2000.
22. Hlastala MP, Robertson HT, Ross BK. Gas exchange abnormalities produced by venous gas emboli. Respir Physiol 36:1-17, 1979.
23. Jones JP Jr, Neuman TS. Dysbaric Osteonecrosis. London: Saunders, 2003.
24. Kerut EK, Norfleet WT, Plotnick GD, Giles TD. Patent foramen ovale: a review of associated conditions and the impact of physiological size. J Am Coll Cardiol 38:613-623, 2001.
25. Kitabatake A, Inoue M, Asao M, Masuyama T, Tanouchi J, Morita T, Mishima M, Uematsu M, Shimazu T, Hori M, Abe H. Noninvasive evaluation of pulmonary hypertension by a pulsed Doppler technique. Circulation 68:302-309, 1983.
26. Knauth M, Ries S, Pohimann S, Kerby T, Forsting M, Daffertshofer M, Hennerici M, Sartor K. Cohort study of multiple brain lesions in sport divers: role of a patent foramen ovale. BMJ 314:701-705, 1997.
27. Levin LL, Stewart GJ, Lynch PR, Bove AA. Blood and blood vessel wall changes induced by decompression sickness in dogs. J Appl Physiol 50:944-949, 1981.
28. Lovering AT, Stickland MK, Kelso AJ, Eldridge MW. Direct demonstration of 25-and 50-μm arteriovenous pathways in healthy human and baboon lungs. Am J Physiol Heart Circ Physiol 292: H1777-H1781, 2007.
29. Marinovic J, Ljubkovic M, Obad A, Breskovic T, Salamunic I, Denoble PJ, Dujic Z. Assessment of extravascular lung water and cardiac function in trimix SCUBA diving. Med Sci Sports Exerc 42:1054-1061, 2010.
30. Meltzer RS, Sartorius OE, Lancee CT, Serruys PW, Verdouw PD, Essed CE, Roelandt J. Transmission of ultrasonic contrast through the lungs. Ultrasound Med Biol 7:377-384, 1981.
31. Moon RE, Camporesi EM, Kisslo JA. Patent foramen ovale and decompression sickness in divers. Lancet 1:513-514, 1989.
32. Nossum V, Hjelde A, Brubakk AO. Small amounts of venous gas embolism cause delayed impairment of endothelial function and increase polymorphonuclear neutrophil infiltration. Eur J Appl Physiol 86:209-214, 2002.
33. Obad A, Palada I, Ivancev V, Valic Z, Fabijanic D, Brubakk AO, Dujic Z. Sonographic detection of intrapulmonary shunting of venous gas bubbles during exercise after diving in a professional diver. J Clin Ultrasound 35:473-476, 2007.
34. Obad A, Palada I, Valic Z, Ivancev V, Bakovic D, Wisloff U, Brubakk AO, Dujic Z. The effects of acute oral antioxidants on diving-induced alterations in human cardiovascular function. J Physiol 578:859-870, 2007.
35. Obad A, Valic Z, Palada I, Brubakk AO, Modun D, Dujic Z. Antioxidant pretreatment and reduced arterial endothelial dysfunction after diving. Aviat Space Environ Med 78:1114-1120, 2007.
36. Pilmanis AA, Meissner FW, Olson RM. Left ventricular gas emboli in six cases of altitude-induced decompression sickness. Aviat Space Environ Med 67:1092-1096, 1996.
37. Pollock N. Use of ultrasound in decompression research. Diving Hyperb Med 37:68-72, 2007.
38. Powell MR. Physiological significance of Doppler-detected bubbles in decompression sickness. In: Proceedings of the Twelfth Undersea Medical Society Workshop, edited by Pearson R. Bethesda, MD: 1977.
39. Powell MR, Thoma W, Fust HD, Cabarrou P. Gas phase formation and Doppler monitoring during decompression with elevated oxygen. Undersea Biomed Res 10:217-224, 1983.
40. Reul J, Weis J, Jung A, Willmes K, Thron A. Central nervous system lesions and cervical disc herniations in amateur divers. Lancet 345:1403-1405, 1995.
41. Sawatzky KD. The Relationship Between Intravascular Doppler-De-tected Gas Bubbles and Decompression Sickness After Bounce Dive in Humans (MSc thesis). Toronto: York University, 1991.
42. Spencer MP, Lawrence GH, Thomas GI, Sauvage LR. The use of ultrasonics in the determination of arterial aeroembolism during open-heart surgery. Ann Thorac Surg 8:489-497, 1969.
43. Stewart MJ. Contrast echocardiography. Heart 89:342-348, 2003.
44. Stickland MK, Welsh RC, Haykowsky MJ, Petersen SR, Anderson WD, Taylor DA, Bouffard M, Jones RL. Intra-pulmonary shunt and pulmonary gas exchange during exercise in humans. J Physiol 561:321-329, 2004.
45. Tetzlaff K, Friege L, Hutzelmann A, Reuter M, Holl D, Leplow B. Magnetic resonance signal abnormalities and neuropsychological deficits in elderly compressed-air divers. Eur Neurol 42:194-199, 1999.
46. Verstappen FT, Bernards JA, Kreuzer F. Effects of pulmonary gas embolism on circulation and respiration in the dog. I. Effects on circulation. Pflügers Arch 368:89-96, 1977. (Pubitemid 8037422)
47. Wilmshurst PT, Byrne JC, Webb-Peploe MM. Relation between interatrial shunts and decompression sickness in divers. Lancet 2:1302-1306, 1989.
48. Yount DE, Hoffman DC. On the use of a bubble formation model to calculate diving tables. Aviat Space Environ Med 57:149-156, 1986.