Scientific papers 2020 - Part A
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Authors:
Richard V. Lundell, Anne K. Räisänen-Sokolowski, Tomi K.
Wuorimaa, Tommi Ojanen, & Tommi Ojanen.
Diving close to the Arctic circle means diving in cold
water regardless of the time of year. The human body
reacts to cold through the autonomous nervous system
(ANS)-mediated thermoregulatory mechanisms. Diving
also induces ANS responses as a result of the diving reflex.
To study ANS responses during diving in Arctic water
temperatures, the authors retrospectively analyzed
repeated 5-min heart rate variability (HRV) measures and
the mean body temperature from dives at regular
intervals using naval diving equipment measurement tests
in 0 degrees C water.
Authors:
Ben Aviner, Ran Arieli, Alexandra Yalov.
Patients undergoing hyperbaric oxygen therapy and
divers engaged in an underwater activity are at risk of
central nervous system oxygen toxicity. An algorithm for
predicting CNS oxygen toxicity during active underwater
diving has been published previously, but not for humans
at rest. Using a procedure similar to that employed for the
derivation of their active diving algorithm, the authors
collected data for exposures at rest, in which subjects
breathed hyperbaric oxygen while immersed in
thermoneutral water at 33 degrees C or in dry conditions.
Authors: Marko Žarak, Antonija Perovic, Marina Njire
Braticevic, Sandra Šupraha Goreta, Jerka Dumic.
Research has shown that a single diving session can lead
to changes in plasma levels of cardiovascular (CV) and
muscular biomarkers. To investigate whether repeated
diving induces an adaptive response in the cardiovascular,
muscular, and immune systems, the authors organized a
study involving one dive per week over five weeks. Each
dive descended to depths of 20 to 30 meters and lasted
30 minutes. This study followed a five-month period
during which the participants did not dive. Fourteen divers
participated in the study, and blood samples were
collected before and after the first, third, and fifth dives.
Specific biomarkers in the plasma or serum were analyzed
using standard laboratory methods.
Author: Tahreem Fatima
This article does not speak of diving but on the use of
Hyperbaric oxygen therapy (HBOT) as a primary
emergency treatment in some acute pathologies or
alternative therapies, particularly in deep and chronic
infections such as necrotizing fasciitis, osteomyelitis,
chronic
soft tissue infections, and infective endocarditis for chronic
long-term pathologies.
Teams equipped with chambers should be informed that
they can be used in case of such pathologies are found
on the worksite.
Authors:
Bobby Glenn Warren, Jason Masker, Gregory Brown,
Isabella Gamez, Becky Smith, Deverick J. Anderson, and
Nicholas Turner
This study evaluates the efficacy of 2 UV-C devices for
disinfection of surfaces contaminated with
epidemiologically important pathogens (EIPs) in
hyperbaric chambers of varying shapes.
Authors:
Juan C Dapena, Corine A Lansdorp, Simon J Mitchell
The authors present the history and imaging of a diver
diagnosed with DCS treated with two US Navy Treatment
Table 6 recompressions but still had multiple extravascular
bubbles apparent on CT-imaging after these hyperbaric
treatments. Based on these findings, they hypothesize that,
contrary to general belief, it is possible that large
extravascular bubbles can persist after definitive treatment
for DCS.
Authors:
Francisco de Asís-Fernández, Tamara del Corral, Ibai
López-de-Uralde-Villanueva
After a maximal apnea, breath-hold divers must restore
O2 levels and clear CO2 and lactic acid produced.
High intensity interval training (HIIT) and inspiratory
muscle training (IMT) could be employed with the aim of
increasing recovery capacity. This study aimed to evaluate
the relative effects of IMT versus HIIT on recovery of
peripheral oxygen saturation (SpO2), and also on
pulmonary function, inspiratory muscle strength, lactate
and heart rate recovery after a maximal dynamic apnea in
breath-hold divers.
Authors:
Peter Germonpré, Paul Van der Eecken, Elke Van
Renterghem, Faye-Lisa Germonpré, Costantino Balestra.
The Azoth Systems O’Dive bubble monitor is marketed at
recreational and professional divers as a tool to improve
personal diving decompression safety. We report the use
of this tool during a l2-day dive trip aboard a liveaboard.
Six divers were consistently monitored according to the
user manual of the O’Dive system. Data were
synchronised with the Azoth server whenever possible
(depending on cell phone data signal). Information
regarding ease of use, diver acceptance and influence on
dive behaviour were recorded.
Authors:
Babak Hajhosseini, Britta A. Kuehlmann, Clark A. Bonham,
Kathryn J. Kamperman, Geoffrey C. Gurtner
As suggested in the title, this document reviews the
various technics used for Hyperbaric Oxygen therapy. It
can be used as a complementary source of information
regarding the positive use of hyperbaric oxygen.
Authors: Brian T Andrew, David J Doolette
The US Navy air decompression table was promulgated in
2008, and a revised version, calculated with the VVal-79
Thalmann algorithm, was promulgated in 2016. The
Swedish Armed Forces conducted a laboratory dive trial
using the 2008 air decompression table and 32 dives to
40 metres‘ seawater for 20 minutes bottom time resulted
in two cases of decompression sickness (DCS) and high
venous gas emboli (VGE) grades. These results motivated
an examination of current US Navy air decompression
schedules.
Authors: Andrzej Molisz,Tomasz Przewozny,Katarzyna
Nowicka-Sauer, Marta Sauer
The role of the cardiovascular system in the development
of seasickness remains uncertain. Material and Methods:
Overall, 18 healthy students (10 males and 8 females)
aged 18–24 years volunteered in the project, spending
2–7 h on life rafts. The cardiovascular system was
examined with impedance cardiography. Susceptibility
and symptoms of seasickness were evaluated by the
Motion Sickness Susceptibility Questionnaire Short-form
(MSSQ-Short) and the Motion Sickness Assessment
Questionnaire (MSAQ). The Visual Analogue Scale (VAS),
ranging 0–10, was used to assess nausea, dizziness and
mood. The parameters were assessed at 2 time points.
Authors: Kåre Segadal, Andreas Møllerløkken
This study was done on initiative from PSA. The objective
was to investigate emergency decompression as an
alternative, in cases where the evacuation from a
saturation facility of divers at increased pressure, is not
available for whatever reason. It is stressed that it will not
be the purpose of such procedures to prevent pain or
discomfort, but to prevent serious injury and death.
Authors:
Brunon Kierznikowicz, Władysław Wolański, Romuald
Olszanski
The article describes a diver performing a dive at small
depths in a dry suit, breathing from a single-stage
apparatus placed on his back. As a result of training
deficiencies, the diver began breathing from inside the
suit, which led to hypoxia and subsequent uncontrolled
ascent. Upon returning to the surface, the diver
developed neurological symptoms based on which a
diagnosis of pulmonary barotrauma was made.
Authors:
Jakub Tlapák, Boris Onišcenko, Petr Došel, Pavel Požár, Petr
Chmátal, and Michal Hájek
Pneumothorax as a consequence of pulmonary
barotrauma during explosive decompression military
crew training in a hypobaric chamber is an extremely rare
and sparsely diagnosed complication. Extensive bilateral
tissue damage is even more unexpected.
Authors:
Xavier CE Vrijdag, Hanna van Waart, Jamie W Sleigh,
Simon J Mitchell
Gas narcosis impairs divers when diving deeper.
Pupillometry is sensitive to alcohol intoxication and it has
been used in anaesthesia to assess nitrous oxide narcosis.
It is a potential novel method to quantify narcosis in
diving. The aim of this study was to evaluate pupillometry
for objective measurement of narcosis during exposure to
hyperbaric air or nitrous oxide.
Authors:
Sergey S. Petrikov, Anatoly K. Evseev, Olga A. Levina, Aslan
K. Shabanov, Vladimir V. Kulabukhov, Natalia Yu.
Kutrovskaya, Natalia V. Borovkova, Elena V. Klychnikova,
Irina V. Goroncharovskaya, Elizaveta V. Tazina, Konstantin
A. Popugaev, Denis A. Kosolapov, Daria S. Slobodeniuk
Patients diagnosed with new coronavirus infection caused
by SARS-CoV-2 virus were examined. Hyperbaric oxygen
therapy sessions were conducted on 57 patients, 38 in
severe condition (CT 3–4) and 19 in moderate condition
(CT 1–2). The procedures were performed in the 1.4–1.6
ATA mode for 40 minutes, 247 sessions were performed.
The effect of hyperbaric oxygenation was assessed by
measuring the level of oxygen saturation, the severity of
oxidative stress, and the apoptosis of blood lymphocytes.
Author: Amy Elizabeth King
This paper focuses on decompression sickness (DCS)
resulting from hyperbaric exposure, specifically,
underwater diving. The US Navy uses probabilistic
decompression models to gain insight into the level of risk
posed by a particular time-depth profile. These models
quantify the probability of DCS occurring using survival
analysis and a gas content or bubble volume model to
define the risk. Current probabilistic models make a
binomial prediction of the probability of DCS occurring
and not occurring.
Authors: Stecia-Marie P. Fletcher, Natalia Ogrodnik, and
Meaghan A. O’Reilly
The authors developed a short-burst, phase-locked
focused ultrasound to address standing waves in the
human spinal canal. They demonstrated that microbubble
emissions from these pulses can effectively open the
blood-spinal cord barrier,which can be detected through
the human vertebral arch.Using a dual aperture approach
and pulse inversion (PI) at 514 kHz, the authors sonicated
circulating microbubbles through ex vivo human
vertebrae.
Authors: Mary Mallappallil, Jacob Sabu, Angelika
Gruessner, and Moro Salifu
Big data refers to extensive datasets that traditional
software cannot handle. The medical field is likely to use it
more in various sectors, including business, academia,
government, and public areas. This includes all sorts of
health data, such as biobanks, wellness devices, medical
records, demographics, and images. Big data is also
changing research methods. Due to more affordable
computing, it is easier to gather massive amounts of data,
use biobanks, design more adaptable studies, and boost
teamwork across different sectors.
Authors: Amy E. King, Laurens E. Howle
This work focuses on hyperbaric exposure, particularly
decompression sickness (DCS) resulting from diving. The
signs and symptoms of DCS can range from mild rashes
and joint pain to severe neurological and cardiac
dysfunction, and even death. In this paper, a probabilistic
model for predicting the tetranomial outcomes of severe,
mild, marginal, and no DCS, was analyzed and compared
with the trinomial and trinomial marginal models from a
previous paper.
Authors: Qiang Yao, Feng Xu, and Jiabao Lin
This document is a qualitative research study on pre-
performance routines (PPRs) specific to elite Chinese
athletes in competitive diving. It identifies and categorizes
the components and stages of PPRs in diving, providing a
comprehensive understanding of the psychological and
behavioral patterns involved. It informs the development
of PPRs for diving athletes and suggests directions for
future research on PPRs in other sports.
This text informs and cautions about the challenges and
risks associated with recreational diving during the COVID-
19 pandemic. It highlights the impact of global preventive
measures on healthcare resources, the difficulties in
maintaining safety protocols during diving, and the
potential risks of diving-related illnesses that may be
exacerbated by the current scarcity of medical resources
and hyperbaric chambers, in addition to raise awareness
about the complications and necessary precautions for
diving activities in the context of the pandemic.
Authors: Johnny Conkin, Ph.D.
This document intends to present research findings and
methodologies related to decompression sickness (DCS)
and venous gas emboli (VGE) in the context of hypobaric
decompressions, particularly for astronauts. It aims to
explain the probabilistic nature of DCS, describe the
methods used to model and predict the occurrence of
DCS and VGE and discuss the implications of these
models for planning extravehicular activities (EVAs) in
space exploration.
Authors: Gianluca Di Muro, F. Gregory Murphy, Richard D.
Vann, Laurens E. Howle
This research focused on developing and evaluating
interconnected tissue compartmental models for
predicting decompression sickness (DCS) in compressed
gas diving, outlining the extension of previous models to
include multiple risk-bearing compartments and discussing
the training and evaluation of these models using a large
dataset. The report also highlights the exploration of
model performance, particularly in predicting DCS in
humans for dives outside the training set, and identifies
the most successful model configuration.
Author: Ryszard Kłos
This document provides information about applying and
evaluating a sonography technique, specifically the
Doppler method, for detecting the free gas phase in
intravascular settings related to decompression research. It
discusses the methodological approach, including the use
of Bayesian validation, and highlights the differing
opinions on the effectiveness of this method in predicting
decompression risk. It also provides historical context on
how this technique has been adopted and developed by
various countries, particularly by the Polish Naval
Academy, which has been using it for over 25 years.
Authors: Eduardo García, Simon J Mitchell
This document presents a scientific study on the
pathophysiology of cutaneous decompression sickness
(DCS), specifically cutis marmorata, in divers. It aims to
share findings from an investigation that used ultrasound
and echocardiography to examine the presence of
bubbles in the skin and the potential role of a right-to-left
shunt (RLS) in the condition. It also discusses hypotheses
about the formation and movement of bubbles in the skin
and suggests that ultrasound can be helpful for further
research in this area.
Authors: Rasads Misirovs, and Shwan Mohamad
A young female patient presented to ear, nose, and throat
clinic with long history of left sided facial pain exacerbated
while flying and being in high altitude. Examination of
nasal cavity and computed tomography scan of sinuses
suggested left maxillary sinus barotrauma. Endoscopic
sinus surgery was performed completely resolving her
symptoms. Based on her symptoms and examination
findings she had reverse squeeze sinus barotrauma.
18 - Hyperacute brain magnetic resonance imaging of
decompression illness in a commercial breath-hold diver
- Published by Clinical Case Reports - Wiley
Authors: Kiyotaka Kohshi, Yoshitaka Morimatsu,
Hideki Tamaki, Tatsuya Ishitake, Petar J. Denoble
Decompression illness in breath-hold diving is a rare
dysbaric disease mainly characterized by stroke-like
neurological disorders. The early use of diffusion-
weighted imaging (DWI) and Magnetic resonance
imaging (MRI) combined with apparent diffusion
coefficient (ADC) map in suspected cases can help in the
early diagnosis and treatment.
07 - Hyperacute brain magnetic resonance imaging of
decompression illness in a commercial breath-hold diver
- Published by Diving and Hyperbaric Medicine
Author: Ran Arieli
This article discusses the reduction of central nervous
system oxygen toxicity (CNS-OT) seizures during
hyperbaric oxygen treatment (HBOT) following the
introduction of a 5-minute air break. It introduces the
power equation as a predictive model for pulmonary and
CNS oxygen toxicity and explains how incorporating
recovery time with air breaks reduces toxicity. The article
calls for further data analysis to calibrate this model for
resting conditions to improve HBOT protocols.
08 - Pulmonary barotrauma: a case report with illustrative radiology
- Published by Diving and Hyperbaric Medicine
Authors: Sarah Bigeni, Mario Saliba
A case of a 24-year-old gentleman who had pulmonary
barotrauma (PBT) after diving is reported. He presented
with chest pain after the second oftwo uneventful
shallow SCUBA dives. Computerized tomography (CT)
scan confirmed the diagnosis and he was treated
conservatively. Relevant radiology and a discussion of PBT
are presented.
09 - Comparison of tissue oxygenation achieved breathing oxygen
using different delivery devices and flow rates
- Published by Diving and Hyperbaric Medicine
Authors: Denise F Blake, Melissa Crowe, Daniel Lindsay,
Simon J Mitchell, Peter A Leggat, Neal W Pollock
This study evaluated oxygen delivery effectiveness and
user comfort across different oxygen delivery devices in
healthy divers. Measuring tissue oxygen partial pressure at
multiple limb sites while breathing 100% oxygen, it
compared a demand valve with intraoral mask, a medical
oxygen rebreathing system (MORS) with two mask types,
and a non-rebreather mask (NRB) at varying flow rates.
Results showed similar oxygen delivery performance for
most devices and flow rates except for lower values with
NRB at 10 L/min. Despite comparable oxygenation, the
NRB was rated highest for comfort and ease of use,
highlighting important aspects when selecting oxygen
delivery methods for decompression illness management.
10 - Factors influencing the severity of long-term sequelae in
fishermen-divers with neurological decompression sickness
- Published by Diving and Hyperbaric Medicine
Authors: Jean-Eric Blatteau, Kate Lambrechts, Jean Ruffez
This study investigates the factors influencing the long-
term outcomes of neurological decompression sickness
(DCS) in Vietnamese fishermen-divers. Twenty-seven
divers who experienced neurological DCS with persistent
sequelae for an average of nine years were assessed. The
research identified that a high initial severity score
significantly increases the risk of severe long-term
sequelae. Additionally, certain treatment methods,
including in-water recompression beyond 17 meters and
prolonged, non-standardized hyperbaric oxygen therapy
initiated late after the accident, are associated with worse
long-term outcomes.
11 - Symptoms of central nervous system oxygen toxicity during
100% Oxygen breathing at normobaric pressure with increasing
inspired levels of carbon dioxide: a case report
- Published by Diving and Hyperbaric Medicine
Authors: Mirit Eynan, Yehuda Arieli, Boris Taran, Yoav Yanir
The article discusses the significant danger of central
nervous system oxygen toxicity (CNS-OT) faced by divers
using oxygen-enriched gas mixtures, particularly
highlighting the role of elevated carbon dioxide (CO2)
levels (hypercapnia) as a major risk factor. It presents a
unique case of a combat diving candidate showing CNS-
OT symptoms during a routine normobaric oxygen
training test with increased inspired CO2, despite normal
neurological assessments afterward. The article
emphasizes the importance of CO2 detection and
retention testing to mitigate CNS-OT risk and reviews
related literature on CO2’s impact on CNS-OT
development.
12 - Measurement of peripheral arterial tonometry in patients with
diabetic foot ulcers during courses of hyperbaric oxygen
treatment
- Published by Diving and Hyperbaric Medicine
Authors: Morten Hedetoft, Niels V Olsen, Isabel G Smidt-
Nielsen, Anna M Wahl, Anita Bergström, Anders
Juul, Ole Hyldegaard
This study investigates the impact of hyperbaric oxygen
treatment (HBOT) on endothelial function in patients with
diabetic foot ulcers. The research compares endothelial
function before and after HBOT in diabetic and non-
diabetic patients and correlates these results with serum
insulin growth factor-I (IGF-I) levels. Findings reveal no
significant changes in endothelial function during HBOT,
but a significant reduction in IGF-I is observed in diabetic
subjects after 90 days, suggesting complex vascular
responses to HBOT in diabetic foot ulcer treatment.
13 - Haemoconcentration, not decreased blood temperature,
increases blood viscosity during cold water immersion
- Published by Diving and Hyperbaric Medicine
Authors: Kaitlyn A Rostomily, Douglas M Jones, Carina M
Pautz, Danica W Ito, Michael J Buono
This study investigated how prolonged cold-water
immersion (CWI) affects blood viscosity, specifically
examining the roles of hypothermia (decreased blood
temperature) and haemoconcentration (increased
hematocrit). Ten healthy volunteers were immersed in
10°C water for 90 minutes, leading to a significant drop in
gastrointestinal temperature and an increase in
hematocrit. These changes collectively resulted in a 19%
increase in blood viscosity. However, when blood viscosity
was measured at the lower temperature without changes
in hematocrit, no significant difference was observed.
14 - Professional diver routine health surveillance and certification: an
internet-based satisfaction survey of New Zealand divers
- Published by Diving and Hyperbaric Medicine
Authors: Chris Sames, Des F Gorman, Simon J Mitchell,
Lifeng Zhou
The article assesses the satisfaction levels of New Zealand
professional divers with the national diver certification and
health surveillance system. Despite recent modifications to
the system, no formal evaluation had been conducted to
gauge diver opinions. By analyzing survey responses from
914 divers over 12 months, the study found an overall
85% satisfaction rate. Dissatisfaction was primarily related
to compliance costs, especially among recreational diving
instructors, and was consistent regardless of diving
location. The findings highlight diver feedback as a critical
step in optimizing certification processes.
15 - The current use of wearable sensors to enhance safety and
performance in breath-hold diving: A systematic review
- Published by Diving and Hyperbaric Medicine
Authors: Giovanni Vinetti, Nicola F Lopomo, Anna Tabon,
Nazzareno Fagoni, Guido Ferretti
This article systematically reviews available wearable
sensor technologies applicable to human breath-hold
diving, focusing on their roles in enhancing diver safety
and athletic performance. By analyzing 52 studies, it
identifies key physiological parameters measurable
underwater, such as heart rate, electrocardiogram, blood
pressure, oxygen saturation, and glucose levels. The
review highlights the emergent potential of these sensors
for real-time monitoring in demanding aquatic
environments, addressing challenges in both training
optimization and diver health management.
16 - Diving with hypertension and antihypertensive drugs
- Published by Diving and Hyperbaric Medicine
Authors: Peter E Westerweel, Rienk Rienks, Ahmed Sakr,
Adel Taher
Hypertension is a common condition, which is highly
prevalent amongst scuba divers. As a consequence, a
substantial proportion of divers are hypertensive and/or
on antihypertensive drugs when diving. In this article, we
review available literature on the possible risks of diving in
the presence ofhypertension and antihypertensive drugs.
Guidelines are presented for the diving physician for the
selection of divers with hypertension suitable for diving,
along with advice on antihypertensive treatment best
compatible with scuba diving.
17 - Assessment of pulmonary oxygen toxicity in special operations
forces divers under operational circumstances using exhaled
breath analysis
- Published by Diving and Hyperbaric Medicine
Authors: Thijs T Wingelaar, Paul Brinkman, Rigo
Hoencamp, Pieter-Jan AM van Ooij, Anke-Hilse
Maitland-van der Zee, Markus W Hollmann, Rob
A van Hulst
This study investigates whether volatile organic
compounds (VOCs) associated with pulmonary oxygen
toxicity (POT), previously identified under laboratory
conditions, can also be detected in divers using closed-
circuit oxygen rebreathers in operational settings.
Two dive scenarios were tested with breath samples
collected before and after diving, analyzed by gas
chromatography-mass spectrometry. Results showed
significant increases in two VOCs, 2,4-dimethylhexane
and 3-methylnonane, post-dive in both scenarios,
suggesting these compounds may serve as biomarkers.
40 - Evaluation of the Abbot FreeStyle Optium Neo H blood glucose
meter in the hyperbaric oxygen environment
- Published by Diving and Hyperbaric Medicine
Authors: Carol R Baines, P David Cooper, Geraldine A
O’Rourke, Charne Miller
This study examined how hyperbaric oxygen treatment
(HBOT) influences the accuracy and reliability of fingertip
capillary blood glucose measurements in non-diabetic
individuals. Ten euglycaemic participants underwent a
standardized HBOT session while their blood glucose
levels were simultaneously measured using a point-of-care
glucometer (capillary glucose) and a laboratory analyzer
(venous serum glucose) at three time intervals. The results
showed significant changes in capillary glucose readings
during HBOT, while venous glucose levels remained
stable, indicating that HBOT affects capillary glucose
measurements but not venous blood glucose values.
41 - Clinical problem solving: Mental confusion and hypoxaemia after
scuba diving
- Published by Diving and Hyperbaric Medicine
Authors: Jean-Eric Blatteau, Jean Morin, Romain Roffi,
Arnaud Druelle, Fabrice Sbardella, Olivier
Castagna
This study examined how hyperbaric oxygen treatment
(HBOT) influences the accuracy and reliability of fingertip
capillary blood glucose measurements in healthy non-
diabetic individuals, comparing these results with venous
serum glucose samples analyzed in a lab. Ten
euglycaemic staff members underwent HBOT while
glucose levels were measured at three intervals using
both finger-prick glucometers and venous blood tests.
Findings revealed significant differences in capillary
glucose readings during HBOT, while venous blood
glucose remained stable, indicating that HBOT affects
capillary glucose measurements likely due to changes in
the capillary environment.
42 - Recreational diving in persons with type 1 and type 2 diabetes:
Advancing capabilities and recommendations
- Published by Diving and Hyperbaric Medicine
Authors: Johan H Jendle, Peter Adolfsson, Neal W Pollock
The article reviews the evolving guidelines and practices
for individuals with diabetes who participate in diving
activities. Since the initial formal guidelines in the early
1990s, revisions have been made to address risks,
particularly hypoglycemia, through advances in
pharmacology and technology. Ongoing careful
evaluation, self-monitoring, medication and meal
adjustments, and communication with diving partners
and medical personnel are emphasized. The article
underscores the need for continuous vigilance, graduated
clearance protocols, and adverse event reporting to
ensure safe diving experiences and foster broader
community acceptance.
43 - Recreational diving-related injury insurance claims among Divers
Alert Network Japan members: Retrospective analysis of 321
cases from 2010 to 2014
- Published by Diving and Hyperbaric Medicine
Authors: Yasushi Kojima, Akiko Kojima, Yumi Niizeki,
Kazuyoshi Yagishita
This study analyzes 321 diving-related injury claims
reported to Divers Alert Network Japan (DAN Japan) from
2010 to 2014 to monitor injury trends and enhance safety
measures. Injuries were categorized as decompression
illness (DCI) or trauma, and claimants were grouped by
age and sex. Results showed trauma was the most
common injury, injuries were more frequent among
females across all age groups, and decompression illness
rates did not differ significantly by sex. The data provide
valuable demographic insight due to the insurance
membership context.
44 - Sudden death after oxygen toxicity seizure during hyperbaric
oxygen treatment: Case report
- Published by Diving and Hyperbaric Medicine
Authors: Rutger C Lalieu, René D Bol Raap, Emile FL
Dubois, Rob A van Hulst
This article discusses a rare but severe complication of
hyperbaric oxygen treatment (HBOT) known as acute
cerebral oxygen toxicity (ACOT), which can lead to
generalized seizures. While generally uncommon and
often benign, a fatal case involving a 37-year-old morbidly
obese patient is presented. The article highlights how
obesity and associated physiological changes, including
obesity hypoventilation syndrome, may elevate the risk of
ACOT and complicate emergency response during HBOT.
It underscores the importance of physician awareness,
preventative strategies, and basic airway management
skills to mitigate potentially fatal outcomes during
hyperbaric treatments.
45 - Medical conditions in scuba diving fatality victims in Australia,
2001 to 2013
- Published by Diving and Hyperbaric Medicine
Authors: John Lippmann, David McD Taylor
This study analyzed scuba diving fatalities in Australia from
2001 to 2013 to identify pre-existing medical conditions
that may have contributed to deaths. Reviewing detailed
coronial, medical, and autopsy data from 126 cases, the
study found that 37% of divers had significant medical
conditions potentially linked to their fatal incidents.
Ischaemic heart disease was the most common condition,
while cardiac-related disabling injuries accounted for a
quarter of deaths. Respiratory conditions also played a role
in some cases. Notably, a portion of divers with
contributory medical issues had been recently medically
cleared to dive, suggesting gaps in fitness-to-dive
assessments.
46 - Scuba diving fatalities in Australia, 2001 to 2013:
Diver demographics and characteristics
- Published by Diving and Hyperbaric Medicine
Authors: John Lippmann, Christopher Stevenson, David
McD Taylor
This study analyzed fatal scuba diving incidents from 2001
to 2013 using data from the National Coronial
Information System to identify victim characteristics and
contributing factors. A total of 126 fatalities were
examined, revealing that most victims were middle-aged
overweight males, with high incidences occurring in
popular diving locations such as New South Wales and
Queensland. Many victims were novices, often involved in
training or introductory dives, and frequently lacked a
diving buddy during incidents. The findings highlight the
need for targeted safety interventions and better training
protocols to reduce fatal scuba diving accidents.
47 - Sphenoid sinus mucocele as an unusual differential diagnosis in
diving injuries
- Published by Diving and Hyperbaric Medicine
Authors: Bengusu Mirasoglu, Seren Kirmizi, Samil Aktas
This article discusses a rare case of sphenoid sinus
mucocele, a cystic lesion that gradually enlarges and
causes symptoms such as visual disturbances, ocular
movement abnormalities, and headaches due to pressure
on the cavernous sinus. The lesion can become
symptomatic after sudden changes in sinus cavity volume,
such as barotrauma experienced during diving. The article
presents a diver who developed vertigo, nausea, blurry
vision, and hearing loss after dives, initially treated for inner
ear decompression sickness. However, the actual
diagnosis was sphenoid sinus mucocele, highlighting the
importance of considering rare conditions in divers with
vestibulocochlear symptoms. This is only the second
reported case linking sphenoid sinus mucocele to diving
injuries.
48 - Diving and hyperbaric medicine in the SARS-CoV-2 pandemic
- Published by Diving and Hyperbaric Medicine
Author: Simon J Mitchell
The COVID-19 pandemic presents significant challenges
and uncertainties for the fields of diving and hyperbaric
medicine, primarily due to the role of hypoxia in severe
cases and the potential use of hyperbaric oxygen
treatment (HBOT). While HBOT can temporarily improve
oxygenation, its long-term benefits or antiviral effects
against COVID-19 remain unproven. There are
considerable logistical, safety, and clinical risks associated
with using HBOT in COVID-19 patients, including
exacerbating pulmonary complications. Consequently,
professional bodies advocate caution and recommend
use only within clinical trials. The pandemic also
complicates routine HBOT service delivery because of
infection control, patient vulnerability, and operational
constraints.
49 - Experimental use of flow cytometry to detect bacteria viability
after hyperbaric oxygen exposure: Work in progress report
- Published by Diving and Hyperbaric Medicine
Authors: Miroslav Rozloznik, Alexandra Lochmanova,
Dittmar Chmelar, Michal Hajek, Karin Korytkova,
Monika Cisarikova
This study investigates the effect of hyperbaric oxygen
treatment (HBOT) on the viability of bacteria commonly
involved in soft tissue infections. Using flow cytometry
with specific fluorescent dyes, the researchers assessed
changes in bacterial viability after exposure to elevated
oxygen pressure. The findings revealed that while
Escherichia coli and Staphylococcus aureus remained
largely unaffected, Pseudomonas aeruginosa exhibited a
dose-dependent reduction in viability, and Klebsiella
pneumoniae showed signs of compromised viability
following HBOT. This suggests flow cytometry as an
effective method for detecting bacterial responses to
hyperbaric oxygen.
50 - Diaphragmatic injury a hidden issue for divers following trauma:
Case report
- Published by Diving and Hyperbaric Medicine
Authors: Matthew Summers, Ian C Gawthorpe
This article discusses the challenge of diagnosing
diaphragmatic injuries following trauma, highlighting a
case where such an injury was only discovered after a
patient resumed scuba diving. It emphasizes that
diaphragmatic injuries are frequently missed during initial
evaluations, posing significant risks for individuals who
return to diving post-trauma. The article calls for diving
medicine practitioners to maintain heightened vigilance to
detect these injuries early and prevent complications.
51 - Anxiety impact on scuba performance and underwater
cognitive processing ability
- Published by Diving and Hyperbaric Medicine
Authors: Feng-Hua Tsai, Wen-Lan Wu, Jing-Min Liang,
Hsiu-Tao Hsu, Te-Yuan Chen
This study investigated how trait anxiety influences scuba
diving skills and cognitive function under water. Twenty-
seven divers were divided into low and high anxiety
groups based on the State-Trait Anxiety Inventory scores.
The researchers measured the completion time of
standard diving skills and performance on a number-
Stroop cognitive test both on land and underwater.
Findings revealed that higher trait anxiety was linked to
slower mask clearing and longer cognitive test response
times underwater and on land, while other diving skills
remained unaffected by anxiety levels.
52 - Deep anaesthesia: The Thailand cave rescue and its implications
for management of the unconscious diver underwater
- Published by Diving and Hyperbaric Medicine
Authors: Hanna van Waart, Richard J Harris, Nicholas
Gant, Xavier CE Vrijdag, Craig J Challen, Chanrit
Lawthaweesawat, Simon J Mitchell
In 2018, twelve children and one adult were anesthetized
for a complex underwater cave rescue in Thailand using
full face dive masks (FFMs) believed to provide constant
positive airway pressure (CPAP). This study details the
anesthetic management and evaluates the CPAP
capability of the Interspiro Divator FFM by measuring
pressure differentials inside and outside the mask during
various breathing conditions on open-circuit scuba and
closed-circuit rebreather systems. Findings confirm that
the FFM maintains positive airway pressure during open-
circuit breathing underwater, supporting its use in such
critical rescues.
53 - Adult attention-deficit/hyperactivity disorder prevalence among
commercial divers in South Africa
- Published by Diving and Hyperbaric Medicine
Authors: HannCharles H Van Wijk, WA Jack Meintjes
This article explores the prevalence of adult attention-
deficit/hyperactivity disorder (ADHD) among commercial
divers, highlighting the associated risks such as workplace
accidents, psychiatric comorbidities, risky behaviors, and
complex treatment needs. Using self-reported surveys
based on DSM-5 criteria among 245 commercial divers in
South Africa, the study found that 5.7% met the criteria for
ADHD, predominantly the combined type and generally
mild in form. The occurrence of adult ADHD did not
significantly vary by age, education, or diving
qualifications, suggesting that ADHD presents a relevant
but consistent risk factor across different demographical
segments within the commercial diving community.
54 - Assessment of a dive incident using heart rate variability
- Published by Diving and Hyperbaric Medicine
Authors: André Zenske, Andreas Koch, Wataru Kähler,
Kerstin Oellrich, Clark Pepper, Thomas Muth,
Jochen D Schipke
This study investigates the effects of scuba diving on the
autonomic nervous system (ANS) by analyzing heart rate
variability (HRV) during an unexpected stressful event
underwater. Using a custom waterproof housing for
Holter monitors, ECG data were collected from
experienced divers who experienced a regulator
malfunction causing stress. Analysis revealed changes in
sympatho-vagal balance and varied autonomic responses,
indicating that scuba diving incidents can acutely
influence both sympathetic and parasympathetic activities.
