Experimental trials to assess the risks of decompression sickness in flying after diving.

We conducted experimental trials of flying after diving using profiles near the no-decompression exposure limits for recreational diving. The objective was to determine the dependence of DCS occurrence during or after flight on the length of the preflight surface intervals (PFSI). One to three dives were conducted during a single day with dry, resting subjects in a hyperbaric chamber at depths of 40, 60, or 100 fsw (224, 286, 408 kPa). The dives were followed by PFSI of 3 to 17 hrs and a four-hour altitude exposure at 8,000 ft (75 kPa), the maximum permitted cabin altitude for pressurized commercial aircraft. Forty DCS incidents occurred during or after flight in 802 exposures of 495 subjects. The DCS incidence decreased as PFSI increased, and repetitive dives generally required longer PFSI to achieve low incidence than did single dives (p = 0.0159). No DCS occurred in 52 trials of a 17 hr PFSI, the longest PFSI tested. The results provide empirical information for formulating guidelines for flying in commercial aircraft after recreational diving.

The incidence of venous gas emboli in recreational diving.

From 1989-91, the Divers Alert Network monitored recreational divers for Doppler-detected venous gas emboli (VGE) and depth-time profiles following multi-day, repetitive, multi-level exposures. A Spencer score >0 occurred in 61 of 67 subjects (91%) and 205 of 281 dives (73%). No subject developed decompression sickness (DCS) on monitored days although 102 dives (36.3%) scored at Spencer Grades 2 or 3 (High Bubble Grade, HBG). We recorded the depth-time profiles with Suunto dive computers and estimated exposure severity with a probabilistic decompression algorithm. The HBG incidence increased 53% over the range of exposure severity (p < 0.001) in the divers, was approximately 20% higher for repetitive dives than for first dives, and decreased approximately 25% over the 6-8 days of multi-day diving (p < 0.001) suggesting a phenomenon similar to DCS adaptation. The observed HBG incidence was approximately 20% higher for males than females. Older male divers had a 25% increase in observed incidence of HBG while older female divers showed a 55% increase when compared to their younger counterparts.

Diving methods and decompression sickness incidence of Miskito Indian underwater harvesters.

Diving conditions, dive profiles, and symptoms of decompression sickness (DCS) in a group of Miskito Indian underwater seafood harvesters are described. Dive profiles for 5 divers were recorded with dive computers, and DCS symptoms were assessed by neurological examination and interview. Divers averaged 10 dives a day over a 7-day period with a mean depth of 67 +/- 7 FSW (306 +/- 123 kPa) and average in-water time of 20.6 +/- 6.3 minutes. Limb pain was reported on 10 occasions during 35 man-days of diving. Symptoms were typically managed with analgesic medication rather than recompression. Indices of the decompression stress were estimated from the recorded profiles using a probabilistic model. We conclude that the dives were outside the limits of standard air decompression tables and that DCS symptoms were common. The high frequency of limb pain suggests the potential for dysbaric bone necrosis for these divers.

A mathematical model of diffusion-limited gas bubble dynamics in tissue with varying diffusion region thickness.

The three-region model of gas bubble dynamics consists of a bubble and a well-stirred tissue region with an intervening unperfused diffusion region previously assumed to have constant thickness and uniform gas diffusivity. As a result, the diffusion region gas content remains unchanged as its volume increases with bubble growth, causing dissolved gas in the region to violate Henry's law. Earlier work also neglected the relationship between the varying diffusion region volume and the fixed total tissue volume. The present work corrects these theoretical inconsistencies by postulating a difference in gas diffusivity between an infinitesimally thin layer at the bubble surface and the remainder of the diffusion region, thus allowing both thickness and gas content of the diffusion region to vary during bubble evolution. The corrected model can yield bubble lifetimes considerably longer than those yielded by earlier three-region models, and meets a need for theoretically consistent but relatively simple bubble dynamics models for use in studies of decompression sickness (DCS) in human subjects.

The indigenous fisherman divers of Thailand: diving practices.

Diving practices of a group of indigenous people living on Thailand's west coast were investigated. Village chiefs were first interviewed using a questionnaire. Three hundred and forty-two active divers were then interviewed by health care workers using a second questionnaire. Field observation was used to further develop information and confirm diving practices. Divers in 6 villages, whose basic means of making a living is from diving for marine products such as fish and shellfish, have diving patterns that put them at substantial risk of decompression illness. Breathing air from a primitive compressor through approximately 100 m of air hose, these divers have long bottom times coupled with short surface intervals. Forty-six point two percent of the divers indicated that they would not make a stop during ascent from a long deep dive (40 m for 30 min). When comparing their previous day of diving to the U.S. Navy Standard Air Decompression Table (U.S. Navy, 1993), 72.1% exceeded the no-decompression limits set by the tables. Diving patterns point to a need for more in-depth research into the diving patterns of this indigenous group. Future research should include the use of dive logging devices to record depths and times. There is also a need to provide divers with information and training to reinforce positive practices and strengthen knowledge of the risks associated with their current diving practices.

Mathematical models of diffusion-limited gas bubble dynamics in tissue.

Mathematical models of bubble evolution in tissue have recently been incorporated into risk functions for predicting the incidence of decompression sickness (DCS) in human subjects after diving and/or flying exposures. Bubble dynamics models suitable for these applications assume the bubble to be either contained in an unstirred tissue (two-region model) or surrounded by a boundary layer within a well-stirred tissue (three-region model). The contrasting premises regarding the bubble-tissue system lead to different expressions for bubble dynamics described in terms of ordinary differential equations. However, the expressions are shown to be structurally similar with differences only in the definitions of certain parameters that can be transformed to make the models equivalent at large tissue volumes. It is also shown that the two-region model is applicable only to bubble evolution in tissues of infinite extent and cannot be readily applied to bubble evolution in finite tissue volumes to simulate how such evolution is influenced by interactions among multiple bubbles in a given tissue. Two-region models that are incorrectly applied in such cases yield results that may be reinterpreted in terms of their three-region model equivalents but only if the parameters in the two-region model transform into consistent values in the three-region model. When such transforms yield inconsistent parameter values for the three-region model, results may be qualitatively correct but are in substantial quantitative error. Obviation of these errors through appropriate use of the different models may improve performance of probabilistic models of DCS occurrence that express DCS risk in terms of simulated in vivo gas and bubble dynamics.

Probabilistic gas and bubble dynamics models of decompression sickness occurrence in air and nitrogen-oxygen diving.

Probabilistic models of the occurrence of decompression sickness (DCS) with instantaneous risk defined as the weighted sum of bubble volumes in each of three parallel-perfused gas exchange compartments were fit using likelihood maximization to the subset of the USN Primary Air and N2-O2 database [n = 2,383, mean P(DCS) = 5.8%] used in development of the USN LE1 probabilistic models. Bubble dynamics with one diffusible gas in each compartment were modeled using the Van Liew equations with the nucleonic bubble radius, compartmental volume, compartmental bulk N2 diffusivity, compartmental N2 solubility, and the N2 solubility in blood x compartmental blood flow as adjustable parameters. Models were also tested that included the effects of linear elastic resistance to bubble growth in one, two, or all three of the modeled compartments. Model performance about the training data and separate validation data was compared to results obtained about the same data using the LE1 probabilistic model, which was independently implemented from published descriptions. In the most successful bubble volume model, BVM(3), diffusion significantly slows bubble growth in one of the modeled compartments, whereas mechanical resistance to bubble growth substantially accelerates bubble resolution in all compartments. BVM(3) performed generally on a par with LE1, despite inclusion of 12 more adjustable parameters, and tended to provide more accurate incidence-only estimates of DCS probability than LE1, particularly for profiles in which high fractional O2 gas mixes are breathed. Values of many estimated BVM(3) parameters were outside of the physiologic range, indicating that the model emerged from optimization as a mathematical descriptor of processes beyond bubble formation and growth that also contribute to DCS outcomes. Although incomplete as a mechanistic description of DCS etiology, BVM(3) remains applicable to a wider variety of decompressions than LE1 and affords a conceptual framework for further refinements motivated by mechanistic principles.

Absence of intravascular bubble nucleation in dead rats.

Bubble formation in the inferior vena cavae (IVC) of dead rats was investigated after 6-15-h exposures to air at 123 atm abs (12.5 MPa) and decompression to 1 atm abs at 13.6 atm/min (1.4 MPa/min). The maximum estimated air-supersaturation attained in the IVCs after decompression was 6.1-18.3 atm (0.6-1.8 MPa). Bubbles were detected by light microscopy, buoyancy, and underwater dissection. No bubbles formed in 42 blood-filled IVCs that were isolated from the circulation by ligatures, but bubbles were always observed in unisolated IVCs (P < 0.000005). Other isolated IVCs were filled with tap water, water and bubbles, or water and iron filings. Bubbles formed in 13% of the IVCs filled with tap water, in 16% of the IVCs containing water with preexisting bubbles, and in 80% of the IVCs containing water with iron filings. Results indicate that at the air supersaturations attained in the isolated IVCs a) blood is resistant to de novo bubble formation; b) preexisting bubbles are dissolved by compression; c) bubbles in water originate from preexisting gas nuclei; and d) iron filings harbor gas nuclei that are able to survive 122 atm (12.4 MPa) overpressures and form bubbles on subsequent decompression.

Monitoring of segmental intra- and extracellular volume changes using electrical impedance spectroscopy.

Osmotically induced cellular volume changes in the perfused rat hindlimb were used to validate the use of bioelectrical impedance spectroscopy as a method for observing fluid shifts between the intracellular and extracellular spaces. Electrical impedance spectra were measured as cell volumes were manipulated by perfusion with Krebs-Henseleit solutions having different concentrations of NaCl. A simple equivalent circuit model of current conduction through the monitored tissue was fit to each measured spectrum to obtain segmental values of the equivalent intracellular resistance, membrane capacitance, and extracellular resistance. These parameters are theoretically governed by variations in the average cell volume fraction and ionic concentrations in the intra- and extracellular fluid spaces. In accord with this theoretical dependence, the parameters changed systematically and reversibly in conformance with both the magnitudes and directions of the perfusate concentration changes and the resultant cell volume changes. Results indicate that bioelectrical impedance spectroscopy, coupled with computer-aided equivalent circuit analysis, can be used to monitor segmental intercompartmental fluid shifts at minute-by-minute resolution.

Patency and blood flow in gas denucleated arterial prostheses.

Biomaterials exposed to blood often fail due to thrombosis. Gas nuclei (air) in the material are thrombogenic and a potential cause of failure. The effects of gas nuclei on patency and blood flow were studied in 4 mm diameter arterial grafts (Gore ePTFE; Johnson and Johnson Vitagraft ePTFE; Bard ACG EXS) in the femoropopliteal position of dogs. Control and denucleated (air-free) grafts were implanted bilaterally. Grafts were denucleated by immersion in degassed saline and exposure to 4 torr vacuum and 3,000-20,000 psig pressure. Graft patency was determined at harvest in 46 dogs. Blood flow was measured with acoustic flow probes in eight dogs. Denucleated graft patency was 60% after 2 days of implant while control patency was 22% (P < .05). Measured blood flow was higher in denucleated grafts than in control grafts (P < .02) in 4 of 5 dogs which had significantly different flows. Patency and flow decreased to zero for both control and denucleated grafts over periods of up to 80 days. Air in the control grafts may have been absorbed within several days, leading to late similarity with the denucleated grafts. Thus, removing the air from 4 mm ePTFE grafts decreased acute thrombosis and increased the patency.

The effect of interstitial air on the in vitro thrombogenicity of ePTFE vascular grafts.

Gas trapped in the interstices of the biomaterials used for vascular prostheses causes thrombosis, and the process of eliminating this gas is known as denucleation. An apparatus was developed for testing in the in vitro effects of denucleation on 4 mm I.D. expanded polytetrafluoroethylene (ePTFE) Vitagraft (Johnson and Johnson). The apparatus was designed to ensure that neither the blood nor the grafts came in contact with air. Blood from a single donor was incubated with control and denucleated grafts for 5, 10, 15, 20, and 30 minutes. The thrombus volume in the graft lumen was measured with a computer assisted videometric system. Little thrombus formed by 5 or 10 minutes, but there was less thrombus in the denucleated graft than in the control graft at all times. The differences were statistically significant at 15 and 20 minutes (p < 0.05). Denucleation nearly doubled the thrombus formation time. Thrombus was more adherent to denucleated grafts than to control grafts. These results are consistent with in vivo observations in the rat where denucleation decreased thrombus formation and increased patency duration.

Nitrogen binding to deoxyhemoglobin at high pressures and its relation to changes in hemoglobin-oxygen affinity.

The stoichiometric and thermodynamic properties of nitrogen (N2) binding to human deoxyhemoglobin (Hb) at N2 saturation pressures up to 400 atm were derived from measured N2 solubilities in protein-free buffers (pH 7.1) and in corresponding buffer + Hb (6.5% w/w) solutions at 20.0, 25.0, and 37.0 degrees C. At each temperature, approximately 3 N2 molecules bind per Hb tetramer at N2 pressures of 100 atm, while about 7 N2 molecules bind per tetramer at 400 atm N2 pressure, where available binding sites are still not fully saturated. Calculated N2-Hb binding isotherms are well described by a simple binding model with 12 independent and equivalent binding sites/Hb tetramer. N2 binding at each of the sites is hydrophobic, exhibiting the typical increase of the dissociation enthalpy with temperature. Enthalpies of dissociation are slightly more negative, while corresponding unitary entropies are somewhat less negative than those for the transfer of N2 from olive oil to water. Calculated partial molar volumes of N2 in Hb are positive but less than the corresponding partial molar volumes of N2 in buffer. Results indicate that N2 binding to Hb is accompanied by only small protein conformational changes which entail slight structural destabilization and loss of free volume in the protein that partially accommodates the volume of the N2 ligand. Results are related to previously reported effects of high pressure and high-pressure N2 on HbO2 affinity, illuminating essential features of the molecular mechanisms for these effects.

Growth and mitochondrial respiration of mungbeans (Phaseolus aureus Roxb.) germinated at low pressure.

Mungbean (Phaseolus aureus Roxb.) seedlings were grown hypobarically to assess the effects of low pressure (21-24 kilopascals) on growth and mitochondrial respiration. Control seedlings grown at ambient pressure (101 kilopascals) were provided amounts of O2 equivalent to those provided experimental seedlings at reduced pressure to factor out responses to O2 concentration and to total pressure. Respiration was assayed using washed mitochondria, and was found to respond only to O2 concentration. Regardless of total pressure, seedlings grown at 2 millimoles O2 per liter had higher state 3 respiration rates and decreased percentages of alternative respiration compared to ambient (8.4 millimoles O2 per liter) controls. In contrast, seedling growth responded to total pressure but not to O2 concentration. Seedlings were significantly larger when grown under low pressure. While low O2 (2 millimoles O2 per liter) diminished growth at ambient pressure, growth at low pressure in the same oxygen concentration was enhanced. Respiratory development and growth of mungbean seedlings under low pressure is unimpaired whether oxygen or air is used as the chamber gas, and further, low pressure can improve growth under conditions of poor aeration.

Effects of microgravity on tissue perfusion and the efficacy of astronaut denitrogenation for EVA.

The prevention of astronaut decompression sickness (DCS) during extravehicular activity (EVA) from the Shuttle Orbiter entails basic questions about how the efficacies of pre-EVA denitrogenations are affected by physiological responses and adaptations to microgravity. Many of these questions may be answered, without requiring inflight decompression experiments, when suitable inflight measurements of N2 elimination from spacecrew breathing 100% O2 can be analyzed using an N2 elimination/DCS risk correlation which has been calibrated in ground-based studies. In order to pursue this approach in our laboratory, a potentially flight-applicable, breath-by-breath method for measuring N2 elimination from human subjects breathing 100% O2 for 2-3-h periods has been developed. The present report describes this development with particular emphasis on required methodological accuracy and its achievement in view of certain properties of mass spectrometer performance. A method for the breath-by-breath analysis of errors in measured N2 elimination profiles is also described.

A likelihood analysis of experiments to test altitude decompression protocols for shuttle operations.

The principle of maximum likelihood and the method of linear regression both are used to fit mathematical models to experimental data, but likelihood can be applied to binary data such as the outcome of a decompression, whereas linear regression cannot. Maximum likelihood was applied to 548 individual altitude exposures from 30 experimental pressure profiles tested by NASA and the Air Force. Twelve decompression models were studied including modified Haldane models and models which assume that stationary bubbles cause Type I decompression sickness. The data was best represented by a model in which a bubble in tissue is surrounded by a diffusion barrier, but this representation was statistically indistinguishable from a single tissue Haldane model with a halftime of 508 min. By providing a quantitative measure of the agreement between theory and data, the principle of maximum likelihood offers an opportunity for improving the understanding of decompression mechanisms and for developing safer and faster decompression procedures.

Applicability of Henry's law to hydrogen, helium, and nitrogen solubilities in water and olive oil at 37 degrees C and pressures up to 300 atmospheres.

The solubilities of pure hydrogen, helium, and nitrogen in water and olive oil were measured at 37 degrees C at gas-saturation pressures from 25 to 300 atmospheres. Rigorous thermodynamic criteria were used to assess the applicability of Henry's law to the pressure dependence of the gas solubility in each system. The solubilities of the three gases in water and helium in olive oil followed Henry's law as given by the Krichevsky-Kasarnovsky equation. In contrast, hydrogen and nitrogen in olive oil each attained concentrations high enough to cause significant concentration-dependent variations of the dissolved gas activity coefficient and/or partial molal volume. The consequent deviations from Henry's law were greatest in the nitrogen-oil system, where mole fraction nitrogen solubilities calculated from the Krichevsky-Kasarnovsky equation exceeded measured values by 8, 14, and 23% at 50, 100, and 250 atm, respectively. Incorporation of results into the critical volume model of nitrogen anesthesia, using olive oil as a model of the physiological anesthetic site and literature data for the anesthetic potency of nitrogen in mice breathing high-pressure He-N2-O2 atmospheres, shows that nonideal solution behavior may become important for gases dissolved in physiological hydrophobic regions at biologically active concentrations, even if dissolved gas binding to proteins or other macromolecules is not involved.