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Sherif HM, Albalooshi YM, Al Hashemi A, Feteaha I, Ismail FH, Zaki MK. The use of dive computers in forensic investigations of fatal breath-hold diving accidents: a case study. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00700-8. [PMID: 37648957 DOI: 10.1007/s12024-023-00700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
Freediving is a type of diving in which divers rely solely on how long they can hold their breath underwater during their dive, which is why it can also be referred to as 'breath-hold diving'. Unlike scuba (self-contained underwater breathing apparatus) diving, individuals do not require training or licencing to perform freediving and may not be aware of the risks of this activity. This paper presents a case in which coastguards retrieved a free diver's lifeless body from the seafloor. In most cases such as this, the deceased individual's cause of death would be ruled as drowning. With the deceased diver's dive computer, we concluded that a shallow water blackout caused him to drown. Data from the dive computer were extracted, graphed, and analysed to explain how a skilled swimmer and diver drowned on one of his seemingly ordinary diving trips. The dive computer can be the sole witness to a fatal dive event and provide invaluable information to forensic scientists since the diver is almost always alone. To our knowledge of the available literature, dive computers have been used in scuba diving fatality investigations; however, we believe that they have not been used in death investigations of breath-hold divers. Deficient or hasty conclusions are often based solely on autopsy findings without data collected by diving technicians and investigators. It is crucial to wait to draw conclusions until all possible dive information has been gathered and studied. This study discusses the deficiency in presenting a reasonable idea to the grieving family and friends of how their beloved relative could have drowned even though he was known to be a fit and skilled diver and avid swimmer.
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Affiliation(s)
- Hazem M Sherif
- Forensic Medicine Department, General Department of Forensic Science and Criminology, Dubai Police, GHQ, Dubai, United Arab Emirates
| | - Younis M Albalooshi
- Forensic Medicine Department, General Department of Forensic Science and Criminology, Dubai Police, GHQ, Dubai, United Arab Emirates
| | - Ahmad Al Hashemi
- Forensic Medicine Department, General Department of Forensic Science and Criminology, Dubai Police, GHQ, Dubai, United Arab Emirates
| | - Islam Feteaha
- Forensic Medicine Department, General Department of Forensic Science and Criminology, Dubai Police, GHQ, Dubai, United Arab Emirates
| | - Farha H Ismail
- Medical Laboratory Sciences, University of Minnesota, Minneapolis, USA
| | - Mamdouh Kamal Zaki
- Forensic Medicine Administration, Forensic Medicine Services Center, Taif, Makkah Region, Saudi Arabia.
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Pernett F, Bergenhed P, Holmström P, Mulder E, Schagatay E. Effects of hyperventilation on oxygenation, apnea breaking points, diving response, and spleen contraction during serial static apneas. Eur J Appl Physiol 2023; 123:1809-1824. [PMID: 37060440 PMCID: PMC10363065 DOI: 10.1007/s00421-023-05202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/07/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE Hyperventilation is considered a major risk factor for hypoxic blackout during breath-hold diving, as it delays the apnea breaking point. However, little is known about how it affects oxygenation, the diving response, and spleen contraction during serial breath-holding. METHODS 18 volunteers with little or no experience in freediving performed two series of 5 apneas with cold facial immersion to maximal duration at 2-min intervals. In one series, apnea was preceded by normal breathing and in the other by 15 s of hyperventilation. End-tidal oxygen and end-tidal carbon dioxide were measured before and after every apnea, and peripheral oxygen saturation, heart rate, breathing movements, and skin blood flow were measured continuously. Spleen dimensions were measured every 15 s. RESULTS Apnea duration was longer after hyperventilation (133 vs 111 s). Hyperventilation reduced pre-apnea end-tidal CO2 (17.4 vs 29.0 mmHg) and post-apnea end-tidal CO2 (38.5 vs 40.3 mmHg), and delayed onset of involuntary breathing movements (112 vs 89 s). End-tidal O2 after apnea was lower in the hyperventilation trial (83.4 vs 89.4 mmHg) and so was the peripheral oxygen saturation nadir after apnea (90.6 vs 93.6%). During hyperventilation, the nadir peripheral oxygen saturation was lower in the last apnea than in the first (94.0% vs 86.7%). There were no differences in diving response or spleen volume reduction between conditions or across series. CONCLUSIONS Serial apneas revealed a previously undescribed aspect of hyperventilation; a progressively increased desaturation across the series, not observed after normal breathing and could heighten the risk of a blackout.
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Affiliation(s)
- Frank Pernett
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden.
| | - Pontus Bergenhed
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Pontus Holmström
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Eric Mulder
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Erika Schagatay
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Swedish Winter Sports Research Centre, Östersund, Sweden
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Barković I, Jurilj Z, Marinelli F, Maričić V, Pavlović M, Turk Wensveen T, Peršić V. Arterial blood gases' analysis in elite breath-hold divers at extreme depths. Eur J Appl Physiol 2023; 123:857-865. [PMID: 36512132 DOI: 10.1007/s00421-022-05110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To showcase results of arterial blood gases' analysis in elite breath-hold divers sampled at depths where their total lung capacities are below their residual lung volume on surface. METHODS Three male elite breath-hold divers performed body plethysmographies to determine their lung volumes. Two dives were performed, one on normal inhalation to 60 m of depth and the second on complete exhalation to 10 m of depth. Blood samples were taken on five occasions; before the first dive, at 60 and 10 m of depth and immediately after resurfacing after both dives. RESULTS Arterial blood gases' analysis at 60 m of depth showed an increase in partial pressures of oxygen and carbon dioxide, a consequent decrease in pH and an increase in concentration of HCO3-. After resurfacing, in two divers, values mostly returned to normal; hypoxemia was observed in one diver. At 10 m of depth, all values showed similar variation, and hypoxemia was observed in the same diver but at depth. Upon resurfacing, all values returned to normal. CONCLUSION This is the first study performed at depths where the total lung capacities of participants are below their residual lung volumes at the surface. Partial pressure of carbon dioxide increases at depth to higher than normal values causing pH to decrease thus exceeding the buffering potential of the blood. In addition, previous assumptions that maximum depth in breath-hold divers is where total lung capacity is reduced to their residual volume proved wrong as our group of divers had no symptoms after resurfacing.
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Affiliation(s)
- Igor Barković
- Faculty of Medicine, Center for Research and Education in Underwater, Hyperbaric and Maritime Medicine, University of Rijeka, Rijeka, Croatia.
- Department for Underwater and Hyperbaric Medicine, University Hospital Rijeka, Rijeka, Croatia.
- Department of Pulmonology, Clinic for Internal Medicine, University Hospital Rijeka, Rijeka, Croatia.
| | - Zdravko Jurilj
- Faculty of Medicine, Center for Research and Education in Underwater, Hyperbaric and Maritime Medicine, University of Rijeka, Rijeka, Croatia
- Department for Underwater and Hyperbaric Medicine, University Hospital Rijeka, Rijeka, Croatia
- Department of Anesthesiology and Intensive Care Unit, University Hospital Rijeka, Rijeka, Croatia
| | - Frano Marinelli
- Faculty of Medicine, Center for Research and Education in Underwater, Hyperbaric and Maritime Medicine, University of Rijeka, Rijeka, Croatia
- Department for Underwater and Hyperbaric Medicine, University Hospital Rijeka, Rijeka, Croatia
- Department of Pulmonology, Clinic for Internal Medicine, University Hospital Rijeka, Rijeka, Croatia
| | - Vitomir Maričić
- AIDA - International Association for the Development of Apnea, Rijeka, Croatia
| | - Marijana Pavlović
- Department of Pulmonology, Clinic for Internal Medicine, University Hospital Rijeka, Rijeka, Croatia
| | - Tamara Turk Wensveen
- Specialized Hospital for Medical Rehabilitation of Cardiac, Pulmonary and Rheumatic Diseases, Thalassotherapia Opatija, Opatija, Croatia
| | - Viktor Peršić
- Specialized Hospital for Medical Rehabilitation of Cardiac, Pulmonary and Rheumatic Diseases, Thalassotherapia Opatija, Opatija, Croatia
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Mulder E, Sieber A, McKnight C, Schagatay E. Underwater pulse oximetry reveals increased rate of arterial oxygen desaturation across repeated freedives to 11 metres of freshwater. Diving Hyperb Med 2023; 53:16-23. [PMID: 36966518 PMCID: PMC10318178 DOI: 10.28920/dhm53.1.16-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/26/2022] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Recreational freedivers typically perform repeated dives to moderate depths with short recovery intervals. According to freediving standards, these recovery intervals should be twice the dive duration; however, this has yet to be supported by scientific evidence. METHODS Six recreational freedivers performed three freedives to 11 metres of freshwater (mfw), separated by 2 min 30 s recovery intervals, while an underwater pulse oximeter measured peripheral oxygen saturation (SpO2) and heart rate (HR). RESULTS Median dive durations were 54.0 s, 103.0 s and 75.5 s (all dives median 81.5 s). Median baseline HR was 76.0 beats per minute (bpm), which decreased during dives to 48.0 bpm in dive one, 40.5 bpm in dive two and 48.5 bpm in dive three (all P < 0.05 from baseline). Median pre-dive baseline SpO2 was 99.5%. SpO2 remained similar to baseline for the first half of the dives, after which the rate of desaturation increased during the second half of the dives with each subsequent dive. Lowest median SpO2 after dive one was 97.0%, after dive two 83.5% (P < 0.05 from baseline) and after dive three 82.5% (P < 0.01 from baseline). SpO2 had returned to baseline within 20 s after all dives. CONCLUSIONS We speculate that the enhanced rate of arterial oxygen desaturation across the serial dives may be attributed to a remaining 'oxygen debt', leading to progressively increased oxygen extraction by desaturated muscles. Despite being twice the dive duration, the recovery period may be too short to allow full recovery and to sustain prolonged serial diving, thus does not guarantee safe diving.
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Affiliation(s)
- Eric Mulder
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Corresponding author: Eric Mulder, Mid Sweden University, Kunskapens väg 8, 83125 Östersund, Sweden
| | - Arne Sieber
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- OXYGEN Scientific GmbH, Feldkirchen, Austria
| | - Chris McKnight
- Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, St Andrews, Scotland
| | - Erika Schagatay
- Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
- Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
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5
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Blogg SL, Tillmans F, Lindholm P. The risk of decompression illness in breath-hold divers: a systematic review. Diving Hyperb Med 2023; 53:31-41. [PMID: 36966520 PMCID: PMC10106275 DOI: 10.28920/dhm53.1.31-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/26/2022] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Breath-hold (BH) diving has known risks, for example drowning, pulmonary oedema of immersion and barotrauma. There is also the risk of decompression illness (DCI) from decompression sickness (DCS) and/or arterial gas embolism (AGE). The first report on DCS in repetitive freediving was published in 1958 and from then there have been multiple case reports and a few studies but no prior systematic review or meta-analysis. METHODS We undertook a systematic literature review to identify articles available from PubMed and Google Scholar concerning breath-hold diving and DCI up to August 2021. RESULTS The present study identified 17 articles (14 case reports, three experimental studies) covering 44 incidences of DCI following BH diving. CONCLUSIONS This review found that the literature supports both DCS and AGE as potential mechanisms for DCI in BH divers; both should be considered a risk for this cohort of divers, just as for those breathing compressed gas while underwater.
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Affiliation(s)
| | | | - Peter Lindholm
- Department of Emergency Medicine, University of California, San Diego, CA, USA
- Corresponding author: Professor Peter Lindholm, 200 W Arbor Drive, MC8676, San Diego, CA 92103, USA
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6
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Diacono E, Magri K. Recurrent dysbarism presenting with amnesia and hypoaesthesia in a professional breath-hold diver. Diving Hyperb Med 2022; 52:213-216. [PMID: 36100933 PMCID: PMC9722340 DOI: 10.28920/dhm52.3.213-216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Abstract
Dysbarism is a medical condition arising from change in ambient pressure which outpace the rate at which the body adapts to it. We report a case of recurrent dysbarism consistent with possible decompression illness presenting with amnesia, hypoaesthesia and other neurological manifestations in a professional breath-hold diver treated successfully with hyperbaric oxygen and fluid resuscitation.
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Affiliation(s)
- Emily Diacono
- University of Malta, Msida, Malta
- Corresponding author: Ms Emily Diacono, University of Malta, Msida, Malta,
| | - Kurt Magri
- Baromedicine Department, Hyperbaric Unit, Mater Dei Hospital, Msida, Malta
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7
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Vitali L, Raffi M, Piras A. Acute Cardiovascular and Metabolic Effects of Different Warm-Up Protocols on Dynamic Apnea. J Sports Sci Med 2022; 21:298-307. [PMID: 35719233 PMCID: PMC9157517 DOI: 10.52082/jssm.2022.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to evaluate the acute physiological response to different warm-up protocols on the dynamic apnea performance. The traditional approach, including a series of short-mid dives in water (WET warm-up), was compared to a more recent strategy, consisting in exercises performed outside the water (DRY warm-up). Nine athletes were tested in two different sessions, in which the only difference was the warm-up executed before 75m of dynamic apnea. Heart rate variability, baroreflex sensitivity, hemoglobin, blood lactate and the rate of perceived exertion were recorded and analyzed. With respect to WET condition, DRY showed lower lactate level before the dive (1.93 vs. 2.60 mmol/L, p = 0.006), higher autonomic indices and lower heart rate during the subsequent dynamic apnea. A significant correlation between lactate produced during WET with the duration of the subsequent dynamic apnea, suggests that higher lactate levels could affect the dive performance (72 vs. 70 sec, p = 0.028). The hemoglobin concentration and the rate of perceived exertion did not show significant differences between conditions. The present findings partially support the claims of freediving athletes who adopt the DRY warm-up, since it induces a more pronounced diving response, avoiding higher lactate levels and reducing the dive time of a dynamic apnea.
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Affiliation(s)
- Luca Vitali
- Department for Life Quality Studies, University of Bologna, Italy
| | - Milena Raffi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Alessandro Piras
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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8
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Meyer HL, Minnemann F, Polan C, Burggraf M, Dudda M, Kauther MD. Injuries in underwater rugby: a retrospective cross-sectional epidemiological study. Diving Hyperb Med 2021; 51:282-287. [PMID: 34547779 DOI: 10.28920/dhm51.3.282-287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 05/19/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Underwater rugby (UWR) is a team sport which combines swimming sprints, apnoea diving, a good overview of the three-dimensional underwater space and wrestling for the ball.This was the first epidemiological study of UWR injuries in a large international collective. METHODS A questionnaire containing 124 questions was distributed to 198 active UWR players and completed under the supervision of medical staff. Demographic data and information about injuries in ten different body regions were collected. RESULTS Of the 198 respondents, 106 (53.5%) were male and 92 (46.5%) were female. On average, each UWR player suffered a median of 19.5 (IQR 44) injuries. Based on the exposure time, means of 37.7 (SD 90.0) injuries per 1000 playing hours per player and 9.9 (20.1) injuries per year were found. Significant injuries mainly occurred to the head region (45.7%). Bruises and sprains were observed more often than fractures and dislocations. Male athletes had a longer total injury break time (median 4.8 [IQR 10.5] days), than female athletes (4 [8.6] days). Female athletes had more injuries (median 20 [IQR 26.8]) than male athletes (18.5 [63]). The length of the injury-related break time increased with the rise in body mass index. CONCLUSIONS The risk of severe injury in UWR is low compared to other ball sports like water polo and rugby. UWR is played under water and the impact of tackles is lessened by the water. Further studies should record chronic injuries in UWR and establish measures to prevent injury.
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Affiliation(s)
- Heinz-Lothar Meyer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen.,Dr med Heinz -Lothar Meyer, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany. ORCID: 0000-0002-3472-4758.
| | - Felicitas Minnemann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen
| | - Christina Polan
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen
| | - Manuel Burggraf
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen
| | - Marcel Dudda
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen
| | - Max D Kauther
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen
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9
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Cialoni D, Brizzolari A, Sponsiello N, Lancellotti V, Lori C, Bosco G, Marroni A, Barassi A. Serum Cardiac and Skeletal Muscle Marker Changes in Repetitive Breath-hold Diving. Sports Med Open 2021; 7:58. [PMID: 34417928 DOI: 10.1186/s40798-021-00349-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022]
Abstract
Background Breath-hold diving (BH-diving) is associated to extreme environmental conditions, prolonged physical activity, and complex adaptation mechanisms to supply enough O2 to vital organs. Consequently, one of the biggest effects could be an increased exercise-induced muscle fatigue, in both skeletal and cardiac muscles that can induce an increase of muscles injury markers including creatine kinase (CK), aspartate transferase (AST), and alanine transferase (ALT) when concerning the skeletal muscle, cardiac creatine kinase isoenzyme (CK-MBm) and cardiac troponin I (cTnI) when concerning the cardiac muscle, and lactate dehydrogenase (LDH) as index of muscle stress. The aim of this study is to investigate serum cardiac and skeletal muscle markers before and after a BH-diving training session. Results We found statistically significant increases of CK (T0: 136.1% p < 0.0001; T1: 138.5%, p < 0.0001), CK-MBm (T0: 145.1%, p < 0.0001; T1: 153.2%, p < 0.0001) LDH (T0: 110.4%, p < 0.0003; T1: 110.1%, p < 0.0013) in both T0 and T1 blood samples, as compared to basal value. AST showed a statistically significant increase only at T0 (106.8%, p < 0.0007) while ALT did not exhibit statistically significant changes. We did not find any changes in cTnI levels between pre-dive and post-dive samples. Conclusions Our data seem to indicate that during a BH-diving training session, skeletal and cardiac muscles react to physical effort releasing stress-related substances. Although the peculiar nature of BH-diving makes it difficult to understand if our results are related only to exercise induced muscle adaptation or whether acute hypoxia or a response to environmental changes (pressure) play a role to explain the observed changes, further studies are needed to better understand if these biomarker changes are linked to physical exercise or to acute hypoxia, or if both conditions play a role. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00349-z.
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10
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Valdivia-Valdivia JM, Räisänen-Sokolowski A, Lindholm P. Prolonged syncope with multifactorial pulmonary oedema related to dry apnoea training: Safety concerns in unsupervised dry static apnoea. Diving Hyperb Med 2021; 51:210-215. [PMID: 34157738 DOI: 10.28920/dhm51.2.210-215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/07/2021] [Indexed: 11/05/2022]
Abstract
Many competitive breath-hold divers use dry apnoea routines to improve their tolerance to hypoxia and hypercapnia, varying the amount of prior hyperventilation and lung volume. When hyperventilating and exhaling to residual volume prior to starting a breath-hold, hypoxia is reached quickly and without too much discomfort from respiratory drive. Cerebral hypoxia with loss of consciousness (LOC) can easily result. Here, we report on a case where an unsupervised diver used a nose clip that is thought to have interfered with his resumption of breathing after LOC. Consequently, he suffered an extended period of severe hypoxia, with poor ventilation and recovery. He also held his breath on empty lungs; thus, trying to inhale created an intrathoracic sub-atmospheric pressure. Upon imaging at the hospital, severe intralobular pulmonary oedema was noted, with similarities to images presented in divers suffering from pulmonary barotrauma of descent (squeeze, immersion pulmonary oedema). Describing the physiological phenomena observed in this case highlights the risks associated with unsupervised exhalatory breath-holding after hyperventilation as a training practice in competitive freediving.
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Affiliation(s)
- Juan M Valdivia-Valdivia
- Neurosurgery Department, St. Joseph's Hospital, Tampa FL, USA.,International Association for Development of Apnea (AIDA International) - Medical and Science Committee, Zurich, Switzerland.,Corresponding author: Professor Peter Lindholm, Department of Emergency Medicine, University of California San Diego, San Diego CA, USA,
| | - Anne Räisänen-Sokolowski
- Pathology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.,The Centre for Military Medicine, The Finnish Defense Forces, Helsinki, Finland
| | - Peter Lindholm
- Department of Emergency Medicine, University of California San Diego, San Diego CA, USA
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11
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Kohshi K, Tamaki H, Lemaître F, Morimatsu Y, Denoble PJ, Ishitake T. Diving-related disorders in commercial breath-hold divers (Ama) of Japan. Diving Hyperb Med 2021; 51:199-206. [PMID: 34157736 DOI: 10.28920/dhm51.2.199-206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/02/2021] [Indexed: 11/05/2022]
Abstract
Decompression illness (DCI) is well known in compressed-air diving but has been considered anecdotal in breath-hold divers. Nonetheless, reported cases and field studies of the Japanese Ama, commercial or professional breath-hold divers, support DCI as a clinical entity. Clinical characteristics of DCI in Ama divers mainly suggest neurological involvement, especially stroke-like cerebral events with sparing of the spinal cord. Female Ama divers achieving deep depths have rarely experienced a panic-like neurosis from anxiety disorders. Neuroradiological studies of Ama divers have shown symptomatic and/or asymptomatic ischaemic lesions situated in the basal ganglia, brainstem, and deep and superficial cerebral white matter, suggesting arterial insufficiency. The underlying mechanism(s) of brain damage in breath-hold diving remain to be elucidated; one of the plausible mechanisms is arterialization of venous nitrogen bubbles passing through right to left shunts in the heart or lungs. Although the treatment for DCI in Ama divers has not been specifically established, oxygen breathing should be given as soon as possible for injured divers. The strategy for prevention of diving-related disorders includes reducing extreme diving schedules, prolonging surface intervals and avoiding long periods of repetitive diving. This review discusses the clinical manifestations of diving-related disorders in Ama divers and the controversial mechanisms.
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Affiliation(s)
- Kiyotaka Kohshi
- Division of Neurosurgery, Nishinihon Hospital, Kumamoto, Japan.,Department of Environmental Medicine, Kurume University School of Medicine, Kurume, Japan.,Corresponding author: Dr Kiyotaka Kohshi, Division of Neurosurgery, Nishinihon Hospital, 3-20-1 Hattanda, Kumamotohigashi, Kumamoto 861-8034, Japan,
| | - Hideki Tamaki
- Department of Environmental Medicine, Kurume University School of Medicine, Kurume, Japan.,Division of Surgery and General Medicine, Tamaki Hospital, Yamaguchi, Japan
| | - Frédéric Lemaître
- Faculty of Sport Sciences, University of Rouen, Mont-Saint-Aignan, France.,CRIOBE USR 3278, CNRS-EPHE-UPVD, PSL, France
| | - Yoshitaka Morimatsu
- Department of Environmental Medicine, Kurume University School of Medicine, Kurume, Japan
| | | | - Tatsuya Ishitake
- Department of Environmental Medicine, Kurume University School of Medicine, Kurume, Japan
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12
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Covington D, Giordano C. Commentary on "Fatal air embolism in a breath-hold diver" and the implied dangers of technical freediving. Diving Hyperb Med 2021; 51:124. [PMID: 33761555 DOI: 10.28920/dhm51.1.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Derek Covington
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville FL, USA.,Corresponding author: Derek Covington, Department of Anesthesiology, University of Florida College of Medicine, Gainesville FL, USA,
| | - Chris Giordano
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville FL, USA
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13
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Elia A, Gennser M, Harlow PS, Lees MJ. Physiology, pathophysiology and (mal)adaptations to chronic apnoeic training: a state-of-the-art review. Eur J Appl Physiol 2021; 121:1543-66. [PMID: 33791844 DOI: 10.1007/s00421-021-04664-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023]
Abstract
Breath-hold diving is an activity that humans have engaged in since antiquity to forage for resources, provide sustenance and to support military campaigns. In modern times, breath-hold diving continues to gain popularity and recognition as both a competitive and recreational sport. The continued progression of world records is somewhat remarkable, particularly given the extreme hypoxaemic and hypercapnic conditions, and hydrostatic pressures these athletes endure. However, there is abundant literature to suggest a large inter-individual variation in the apnoeic capabilities that is thus far not fully understood. In this review, we explore developments in apnoea physiology and delineate the traits and mechanisms that potentially underpin this variation. In addition, we sought to highlight the physiological (mal)adaptations associated with consistent breath-hold training. Breath-hold divers (BHDs) are evidenced to exhibit a more pronounced diving-response than non-divers, while elite BHDs (EBHDs) also display beneficial adaptations in both blood and skeletal muscle. Importantly, these physiological characteristics are documented to be primarily influenced by training-induced stimuli. BHDs are exposed to unique physiological and environmental stressors, and as such possess an ability to withstand acute cerebrovascular and neuronal strains. Whether these characteristics are also a result of training-induced adaptations or genetic predisposition is less certain. Although the long-term effects of regular breath-hold diving activity are yet to be holistically established, preliminary evidence has posed considerations for cognitive, neurological, renal and bone health in BHDs. These areas should be explored further in longitudinal studies to more confidently ascertain the long-term health implications of extreme breath-holding activity.
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Elia A, Gennser M. Considerations for scuba and breath-hold divers during the COVID-19 pandemic: A call for awareness. Diving Hyperb Med 2020; 50:413-416. [PMID: 33325024 DOI: 10.28920/dhm50.4.413-416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 08/28/2020] [Indexed: 12/17/2022]
Abstract
In late 2019, a highly pathogenic novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2 emerged from Wuhan, China and led to a global pandemic. SARS-CoV-2 has a predilection for the pulmonary system and can result in serious pneumonia necessitating hospitalisation. Computed tomography (CT) chest scans of patients with severe symptoms, show signs of multifocal bilateral ground or ground-glass opacities (GGO) associated with consolidation areas with patchy distribution. However, it is less well known that both asymptomatic and mild symptomatic patients may exhibit similar lung changes. Presumably, the various pathological changes in the lungs may increase the risk of adverse events during diving (e.g., lung barotrauma, pulmonary oedema, etc.), thus these lung manifestations need to be considered prior to allowing resumption of diving. Presently, it is not known how the structural changes in the lungs develop and to what extent they resolve, in particular in asymptomatic carriers and patients with mild disease. However, current evidence indicates that a month of recovery may be too short an interval to guarantee complete pulmonary restitution even after COVID-19 infections not demanding hospital care.
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Affiliation(s)
- Antonis Elia
- Division of Environmental Physiology, School of Chemistry, Bioengineering and Health, KTH Royal Institute of Technology, Stockholm, Sweden.,Corresponding author: Dr Antonis Elia, Division of Environmental Physiology, School of Chemistry, Bioengineering and Health, KTH Royal Institute of Technology, Stockholm, Sweden,
| | - Mikael Gennser
- Division of Environmental Physiology, School of Chemistry, Bioengineering and Health, KTH Royal Institute of Technology, Stockholm, Sweden
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15
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de Asís-Fernández F, Del Corral T, López-de-Uralde-Villanueva I. Effects of inspiratory muscle training versus high intensity interval training on the recovery capacity after a maximal dynamic apnoea in breath-hold divers. A randomised crossover trial. Diving Hyperb Med 2020; 50:318-324. [PMID: 33325010 DOI: 10.28920/dhm50.4.318-324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/04/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION After a maximal apnoea, 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 apnoea in breath-hold divers. METHODS Fifteen breath-hold divers performed two training interventions (IMT and HIIT) for 20 min, three days per week over four weeks in randomised order with a two week washout period. RESULTS IMT produced a > 3 s reduction in SpO2 recovery time compared to HIIT. The forced expiratory volume in the first second (FEV1) and maximum inspiratory pressure (MIP) were significantly increased in the IMT group compared to HIIT. The magnitude of these differences in favour of IMT was large in both cases. Neither training intervention was superior to the other for heart rate recovery time, nor in peak- and recovery- lactate. CONCLUSIONS IMT produced a reduction in SpO2 recovery time compared to HIIT after maximal dynamic apnoea. Even a 3 s improvement in recovery could be important in scenarios like underwater hockey where repetitive apnoeas during high levels of exercise are separated by only seconds. IMT also improved FEV1 and MIP, but no differences in lactate and heart rate recovery were found post-apnoea between HIIT and IMT.
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Affiliation(s)
- Francisco de Asís-Fernández
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Breatherapy Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain
| | - Tamara Del Corral
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Breatherapy Research Group, Instituto de Neurociencias y Ciencias del Movimiento (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain.,Corresponding author: Professor Tamara del Corral, Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Spain,
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Spain
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Sadler C, Brett K, Heerboth A, Swisher AR, Mehregani N, Touriel R, Cannon DT. Safety proposals for freediving time limits should consider the metabolic-rate dependence of oxygen stores depletion. Diving Hyperb Med 2020; 50:356-362. [PMID: 33325016 DOI: 10.28920/dhm50.4.356-362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/07/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION There is no required training for breath-hold diving, making dissemination of safety protocols difficult. A recommended breath-hold dive time limit of 60 s was proposed for amateur divers. However, this does not consider the metabolic-rate dependence of oxygen stores depletion. We aimed to measure the effect of apnoea time and metabolic rate on arterial and tissue oxygenation. METHODS Fifty healthy participants (23 (SD 3) y, 22 women) completed four periods of apnoea for 60 s (or to tolerable limit) during rest and cycle ergometry at 20, 40, and 60 W. Apnoea was initiated after hyperventilation to achieve PETCO2 of approximately 25 mmHg. Pulse oximetry, frontal lobe oxygenation, and pulmonary gas exchange were measured throughout. We defined hypoxia as SpO2 < 88%. RESULTS Static and exercise (20, 40, 60 W) breath-hold break times were 57 (SD 7), 50 (11), 48 (11), and 46 (11) s (F [2.432, 119.2] = 32.0, P < 0.01). The rise in PETCO2 from initiation to breaking of apnoea was dependent on metabolic rate (time × metabolic rate interaction; F [3,147] = 38.6, P < 0.0001). The same was true for the fall in SpO2 (F [3,147] = 2.9, P = 0.03). SpO2 fell to < 88% on 14 occasions in eight participants, all of whom were asymptomatic. CONCLUSIONS Independent of the added complexities of a fall in ambient pressure on ascent, the effect of apnoea time on hypoxia depends on the metabolic rate and is highly variable among individuals. Therefore, we contend that a universally recommended time limit for breath-hold diving or swimming is not useful to guarantee safety.
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Affiliation(s)
- Charlotte Sadler
- Department of Emergency Medicine, University of California, San Diego, USA.,Corresponding author: Dr Charlotte Sadler, Department of Emergency Medicine, University of California, San Diego, USA,
| | - Kaighley Brett
- Department of Emergency Medicine, University of California, San Diego, USA
| | - Aaron Heerboth
- Department of Emergency Medicine, University of California, San Diego, USA
| | - Austin R Swisher
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, USA
| | - Nader Mehregani
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, USA
| | - Ross Touriel
- Department of Emergency Medicine, University of California, San Diego, USA
| | - Daniel T Cannon
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, USA
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17
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Bosco G, Paganini M, Rizzato A, Martani L, Garetto G, Lion J, Camporesi EM, Moon RE. Arterial blood gases in divers at surface after prolonged breath-hold. Eur J Appl Physiol 2020; 120:505-512. [PMID: 31912227 DOI: 10.1007/s00421-019-04296-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/29/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Adaptations during voluntary breath-hold diving have been increasingly investigated since these athletes are exposed to critical hypoxia during the ascent. However, only a limited amount of literature explored the pathophysiological mechanisms underlying this phenomenon. This is the first study to measure arterial blood gases immediately before the end of a breath-hold in real conditions. METHODS Six well-trained breath-hold divers were enrolled for the experiment held at the "Y-40 THE DEEP JOY" pool (Montegrotto Terme, Padova, Italy). Before the experiment, an arterial cannula was inserted in the radial artery of the non-dominant limb. All divers performed: a breath-hold while moving at the surface using a sea-bob; a sled-assisted breath-hold dive to 42 m; and a breath-hold dive to 42 m with fins. Arterial blood samples were obtained in four conditions: one at rest before submersion and one at the end of each breath-hold. RESULTS No diving-related complications were observed. The arterial partial pressure of oxygen (96.2 ± 7.0 mmHg at rest, mean ± SD) decreased, particularly after the sled-assisted dive (39.8 ± 8.7 mmHg), and especially after the dive with fins (31.6 ± 17.0 mmHg). The arterial partial pressure of CO2 varied somewhat but after each study was close to normal (38.2 ± 3.0 mmHg at rest; 31.4 ± 3.7 mmHg after the sled-assisted dive; 36.1 ± 5.3 after the dive with fins). CONCLUSION We confirmed that the arterial partial pressure of oxygen reaches hazardously low values at the end of breath-hold, especially after the dive performed with voluntary effort. Critical hypoxia can occur in breath-hold divers even without symptoms.
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Affiliation(s)
- Gerardo Bosco
- Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, 35131, Padova, Italy
| | - Matteo Paganini
- Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, 35131, Padova, Italy.
| | - Alex Rizzato
- Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, 35131, Padova, Italy
| | - Luca Martani
- Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, 35131, Padova, Italy
| | | | - Jacopo Lion
- Master in Diving and Hyperbaric Medicine, Department of Biomedical Sciences, University of Padova, Via Marzolo, 3, 35131, Padova, Italy
| | | | - Richard E Moon
- Department of Anesthesiology, Center for Hyperbaric Medicine and Environmental Physiology, Duke University Medical Center, Durham, NC, USA
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18
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Abstract
Cerebral arterial gas embolism (CAGE) from breath-holding or inadequate exhalation during ascent is a well-recognised complication of scuba diving. It does not usually occur with breath-hold (BH) diving in those with normal lungs, as the volume of gas in the lungs on surfacing cannot exceed what it was on leaving the surface. However, a BH diver who breathes from a compressed gas supply at depth essentially becomes a scuba diver and is at risk of pulmonary barotrauma (PBt) and CAGE on ascent. In this case, a 26-year-old male experienced BH diver breathed from a scuba set at approximately 10 metres' sea water depth and ascended, sustaining massive PBt and CAGE with a fatal outcome. BH and scuba divers, especially those with less experience, need to be well-informed about this potential risk.
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Affiliation(s)
- Neil Dg Banham
- Hyperbaric Medicine Unit, Fiona Stanley Hospital, Perth, Australia
- Corresponding author: Director, Hyperbaric Medicine Unit, Fiona Stanley Hospital, Perth, Australia,
| | - John Lippmann
- Australasian Diving Safety Foundation, Melbourne, Australia
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19
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Lippmann J. Snorkelling and breath-hold diving fatalities in Australia, 2001 to 2013. Demographics, characteristics and chain of events. Diving Hyperb Med 2019; 49:192-203. [PMID: 31523794 DOI: 10.28920/dhm49.3.192-203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/21/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The aim of this study was to identify characteristics of victims of fatal snorkelling and breath-hold diving accidents in Australia from 2001-2013, inclusive, to determine underlying factors and risks associated with such activities and inform appropriate countermeasures. METHODS The National Coronial Information System (NCIS) was searched to identify snorkelling and breath-hold diving-related cases reported to Australian coroners for the years 2001-2013, inclusive. Coronial data in the form of findings, witness and police reports, medical histories and autopsies were collected and collated, and descriptive statistics were used to analyse these data. A chain of events analysis was used to determine the likely sequence of events. RESULTS There were 175 identified snorkelling-related fatalities during the study period. Most victims were middle-aged males (mean age 49 years). Pre-existing health conditions were possible contributors to 41% of the deaths, the main being ischaemic heart disease. The majority of deaths occurred in Queensland in inexperienced snorkellers, often in commercial settings. The victim's plight often went unnoticed as they were alone, or poorly supervised, when the incident occurred. Apnoeic hypoxia appeared to have been associated with at least 12.5% of the deaths. The main disabling injuries were asphyxia (40%) and cardiac incidents (35%). CONCLUSION Human factors, such as chronic health conditions, poor skills and inexperience and poor planning can play a substantial role throughout the chain of events leading to a snorkelling fatality. It is important to educate the community, doctors and dive industry professionals about potential problems associated with the interaction between certain health-related conditions, especially cardiovascular conditions, and snorkelling. Close supervision is strongly recommended for inexperienced snorkellers due to their likely poor skills, as well as for experienced breath-hold divers due to the potential for apnoeic hypoxia.
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Affiliation(s)
- John Lippmann
- Corresponding author: John Lippmann, DAN Asia-Pacific Foundation / Australasian Diving Safety Foundation, PO Box 478, Canterbury, VIC 3126, Australia, .,DAN Asia-Pacific Foundation / Australasian Diving Safety Foundation, Ashburton, Victoria, Australia.,Department of Public Health and Preventative Medicine, Monash University, Victoria, Australia
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20
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de Asís Fernández F, González-Mohino F, González-Ravé JM. Assessment of sensory sensitivity through critical flicker fusion frequency thresholds after a maximum voluntary apnoea. Diving Hyperb Med 2019; 49:186-191. [PMID: 31523793 DOI: 10.28920/dhm49.3.186-191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/30/2019] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The influence of acute exercise on sensory sensitivity (SS) differs according to the type and duration of exercise performed. In the present study, we assessed changes on SS soon after a maximal dynamic apnoea. METHODS Thirty-nine experienced male breath-hold divers were recruited. Critical flicker fusion frequency (CFFF) thresholds were used to measure SS. Thresholds were determined before and after a maximal dynamic apnoea. Immediately after surfacing, heart rate and oxygen saturation (SpO2) were recorded for two minutes. RESULTS After maximal dynamic apnoea, SpO2 was significantly decreased (from mean 97.3% pre-dive to mean 63.1% post-dive; P < 0.0001; η2 P = 0.86), but this acute hypoxaemia did not trigger changes in SS (post-dive value 102% of baseline; P = 0.22; η2 P = 0.03). Pearson correlation analysis revealed a moderate association between SS with swimming speed (r = 0.423) and apnoea time (r = -0.404). CONCLUSIONS A maximal dynamic apnoea did not produce changes in central nervous system fatigue or cortical arousal. We found no relationship between the hypoxaemia level reached after a maximal apnoea and changes in the CFFF thresholds. This study suggests that the time of exposure to hypoxia during a maximal voluntary apnoea is not enough to produce changes in SS.
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Affiliation(s)
- Francisco de Asís Fernández
- Corresponding author: Dr Francisco de Asís Fernández, Departament of Health, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Spain, .,Departament of Health, Centro Superior de Estudios Universitarios La Salle. Universidad Autónoma de Madrid, Spain
| | | | - José M González-Ravé
- Sports Training Laboratory, Faculty of Sports Sciences, University of Castilla-La Mancha, Toledo, Spain
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21
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Yanagawa Y, Omori K, Takeuchi I, Jitsuiki K, Ohsaka H, Ishikawa K. The on-site differential diagnosis of decompression sickness from endogenous cerebral ischaemia in an elderly Ama diver using ultrasound. Diving Hyperb Med 2019; 48:262-263. [PMID: 30517960 DOI: 10.28920/dhm48.4.262-263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 11/07/2018] [Indexed: 11/05/2022]
Abstract
Commercial or occupational breath-hold (BH) harvest divers along the coast and islands of Japan are collectively called Ama divers. Repetitive BH diving by Ama divers may place them at risk of developing neurological decompression sickness (DCS). We report a 74-year-old Ama diver who demonstrated right hemiparesis during an ascent after free diving at a depth of 5 metres' sea water. This report suggests the usefulness of on-site ultrasound for making a differential diagnosis of DCS from endogenous cerebral ischaemia. Further clinical studies of this management approach are warranted.
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Affiliation(s)
- Youichi Yanagawa
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Shizuoka Prefecture, Japan.,Corresponding author: 1129 Nagaoka, Izunokuni City, Shizuoka, Japan 410-2295,
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Shizuoka Prefecture, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Shizuoka Prefecture, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Shizuoka Prefecture, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Shizuoka Prefecture, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Juntendo Shizuoka Hospital, Izunokuni City, Shizuoka Prefecture, Japan
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22
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Morishima R, Nakashima K, Suzuki S, Yamami N, Aoshima M. A diver with immersion pulmonary oedema and prolonged respiratory symptoms. Diving Hyperb Med 2018; 48:259-261. [PMID: 30517959 DOI: 10.28920/dhm48.4.259-261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 11/17/2018] [Indexed: 11/05/2022]
Abstract
Immersion pulmonary oedema (IPE) is particularly associated with an excessive reaction to exercise and/or cold stress. IPE usually resolves without recompression therapy within a day or two. Herein we report a diver diagnosed with IPE, in whom symptoms persisted for five days. A 58-year-old man presented with sudden onset of dyspnoea, cough and haemoptysis after surfacing. He was an experienced diving instructor with a history of moderate mitral valve regurgitation. While IPE was diagnosed and oxygen administered, respiratory symptoms deteriorated, and serum C-reactive protein elevated. No evidence of infection was seen. Three hyperbaric oxygen treatments were given on the basis of suspected decompression sickness, and symptoms subsequently resolved. The recently diagnosed mitral valve regurgitation and inflammatory response were considered to have contributed to the prolongation of symptoms.
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Affiliation(s)
- Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan.,Department of Pulmonary Medicine, Kameda Medical Centre, Kamogawa, Chiba, Japan.,Department of Medicine, Awa Regional Medical Centre, Tateyama, Chiba.,Corresponding author: 183-0042 Musashidai 2-6-1, Fuchu city, Tokyo, 183-0042, Japan,
| | - Kei Nakashima
- Department of Pulmonary Medicine, Kameda Medical Centre, Kamogawa, Chiba, Japan
| | - Shinya Suzuki
- Department of Emergency Medicine, Kameda Medical Centre
| | | | - Masahiro Aoshima
- Department of Pulmonary Medicine, Kameda Medical Centre, Kamogawa, Chiba, Japan
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Lippmann J, Lawrence C, Fock A, Jamieson S. Provisional report on diving-related fatalities in Australian waters in 2012. Diving Hyperb Med 2018; 48:141-167. [PMID: 30199888 PMCID: PMC6205854 DOI: 10.28920/dhm48.3.141-167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/20/2018] [Indexed: 11/05/2022]
Abstract
INTRODUCTION An individual case review of known diving-related deaths that occurred in Australia in 2012 was conducted. METHOD The case studies were compiled using statements from witnesses and reports of the police and coroners. In each case, the particular circumstances of the accident and details from the post-mortem examination, where available, are provided. RESULTS There were 26 reported fatalities (four less than the previous year). Only two of the victims were female (one snorkeller and one scuba diver). Fourteen deaths occurred while snorkelling and/or breath-hold diving, 11 while scuba diving and one diver died while using surface supplied breathing apparatus in a commercial pearl diving setting. Two breath-hold divers likely drowned as a result of apnoeic hypoxia. Cardiac-related issues were thought to have contributed to the deaths of at least three and possibly seven snorkellers and four scuba divers. CONCLUSIONS Pre-existing medical conditions; poor organisation, planning and supervision; equipment-related problems; snorkelling or diving alone or with loose buddy oversight and apnoeic hypoxia were features in several deaths in this series.
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Affiliation(s)
- John Lippmann
- Corresponding author: DAN Asia Pacific, P O Box 384, Ashburton, Victoria 3147, Australia,
- Divers Alert Network Asia-Pacific, Ashburton, Victoria, Australia
- School of Health and Social Development, Deakin University, Victoria, Australia
| | - Chris Lawrence
- Statewide Forensic Medical Services, Royal Hobart Hospital, Tasmania, Australia
| | - Andrew Fock
- Departments of Hyperbaric Medicine and Intensive Care Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Scott Jamieson
- Divers Alert Network Asia-Pacific, Ashburton, Victoria, Australia
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24
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Park J, Kim S, Kim DH, Cha S, Lee JY. Whole-body cold tolerance in older Korean female divers "haenyeo" during cold air exposure: effects of repetitive cold exposure and aging. Int J Biometeorol 2018; 62:543-551. [PMID: 29098422 DOI: 10.1007/s00484-017-1463-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 09/21/2017] [Accepted: 10/13/2017] [Indexed: 06/07/2023]
Abstract
This study was conducted to investigate the effects of chronic and repetitive diving in cold sea water on physiological responses to cold in older Korean female divers, Haenyeo, who have been exposed to cold water through breath-hold diving since their teens. Young and older females, who have no experience of swimming in cold sea water, were recruited as control groups: older haenyeos (N = 10, 70 ± 3 years of age), young non-diving females (N = 10, 23 ± 2 years), and older non-diving females (N = 6, 73 ± 4 years). For the test of cold exposure, all subjects were exposed to cold in an air temperature of 12 °C with 45% RH in a sitting position for 60 min. The changes in core temperature showed no significant differences between older haenyeos and the other two groups. The decreases in mean skin temperature were greater for older haenyeos than the other two groups (P < 0.01). Older haenyeos had significantly lower energy expenditure during cold exposure when compared to older non-diving females (P < 0.05). Heart rate was significantly lower in older haenyeos than that of young non-diving females (P < 0.05). Older haenyeos felt cooler at the face with lower face temperature when compared with older non-diving females. The results indicate that older haenyeos respond to cold through reducing heat loss from the skin rather than increasing metabolic rate. These responses are distinctive features from the cold defensive system of young or older non-diving females.
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Affiliation(s)
- Joonhee Park
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Siyeon Kim
- College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Republic of Korea
| | - Do-Hee Kim
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
| | - Seongwon Cha
- Mibyeong Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Joo-Young Lee
- Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea.
- College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 151-742, Republic of Korea.
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Sponsiello N, Cialoni D, Pieri M, Marroni A. Cellular Glucose Uptake During Breath-Hold Diving in Experienced Male Breath-Hold Divers. Sports Med Open 2018; 4:14. [PMID: 29589215 PMCID: PMC5871611 DOI: 10.1186/s40798-018-0126-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/02/2018] [Indexed: 11/17/2022]
Abstract
Background The physiological and pathophysiological mechanisms that govern diving, both self-contained underwater breathing apparatus (SCUBA) and breath-hold diving (BH-diving), are in large part well known, even if there are still many unknown aspects, in particular about cell metabolism during BH-diving. The scope of this study was to investigate changes in glycemia, insulinemia, and the catecholamine response to BH-diving, to better understand if the insulin-stimulated glucose uptake mechanism is involved in cellular metabolism in this sport. Methods Twenty male experienced healthy breath-hold divers were studied. Anthropometric information was obtained. Glycemia, insulinemia, and catecholamine response were investigated before and after the series of BH-diving. Results We found a statistically significant decrease in the blood glucose levels between before and after dives (mean 94.3 ± 11.6 vs. 83.5 ± 12.5 mg/dl) P = 0.001 and a statistically significant increase in blood insulin value (median 4.5 range 3.4/6.4 vs. 7.0 range 4.2/10.2 mcgU/ml) P < 0.0001. Also, we found a statistically significant increase of catecholamine production (median 14.0 range 8/18 vs. 15.5 range 10.0/21.0 μg) P < 0.0001. Conclusions The increase in blood insulin during BH-diving associated with the decrease of blood glucose levels could indicate that the upregulating cellular uptake is not caused by activation of the specific glucose transporters. Particular diving-related conditions such as the diving reflex, the intermittent hypoxia/hyperoxia, and the particular environmental condition could play an important role in the mechanism involved in glycemia decrease in BH-diving. Our data confirm that the adaptations to BH-diving are caused by complex mechanisms and involve many peculiar responses still in large part unknown. Electronic supplementary material The online version of this article (10.1186/s40798-018-0126-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Danilo Cialoni
- Apnea Academy Research, Padova, Italy. .,DAN Europe Research Division, Contrada Padune 11, 64026, Roseto degli Abruzzi, TE, Italy.
| | - Massimo Pieri
- DAN Europe Research Division, Contrada Padune 11, 64026, Roseto degli Abruzzi, TE, Italy
| | - Alessandro Marroni
- DAN Europe Research Division, Contrada Padune 11, 64026, Roseto degli Abruzzi, TE, Italy
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Abstract
BACKGROUND We have been studying the thermoregulatory responses of Korean breath-hold women divers, called haenyeo, in terms of aging and cold adaptation. During the 1960s to the 1980s, haenyeos received attention from environmental physiologists due to their unique ability to endure cold water while wearing only a thin cotton bathing suit. However, their overall cold-adaptive traits have disappeared since they began to wear wetsuits and research has waned since the 1980s. For social and economic reasons, the number of haenyeos rapidly decreased to 4005 in 2015 from 14,143 in 1970 and the average age of haenyeos is about 75 years old at present. METHODS For the past several years, we revisited and explored older haenyeos in terms of environmental physiology, beginning with questionnaire and field studies and later advancing to thermal tolerance tests in conjunction with cutaneous thermal threshold tests in a climate chamber. As control group counterparts, older non-diving females and young non-diving females were compared with older haenyeos in the controlled experiments. RESULTS Our findings were that older haenyeos still retain local cold tolerance on the extremities despite their aging. Finger cold tests supported more superior local cold tolerance for older haenyeos than for older non-diving females. However, thermal perception in cold reflected aging effects rather than local cold acclimatization. An interesting finding was the possibility of positive cross-adaptation which might be supported by greater heat tolerance and cutaneous warm perception thresholds of older haenyeos who adapted to cold water. CONCLUSIONS It was known that cold-adaptive traits of haenyeos disappeared, but we confirmed that cold-adaptive traits are still retained on the face and hands which could be interpreted by a mode switch to local adaptation from the overall adaptation to cold. Further studies on cross-adaptation between chronic cold stress and heat tolerance are needed.
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Affiliation(s)
- Joo-Young Lee
- Seoul National University, Bld.222-#306, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 South Korea
| | - Joonhee Park
- Seoul National University, Bld.222-#332, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 South Korea
| | - Siyeon Kim
- Seoul National University, Bld.222-#332, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826 South Korea
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Mijacika T, Kyhl K, Frestad D, Otto Barak F, Drvis I, Secher NH, Dujic Z, Lav Madsen P. Effect of pulmonary hyperinflation on central blood volume: An MRI study. Respir Physiol Neurobiol 2017; 243:92-96. [PMID: 28583413 DOI: 10.1016/j.resp.2017.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/31/2017] [Indexed: 11/25/2022]
Abstract
Pulmonary hyperinflation attained by glossopharyngeal insufflation (GPI) challenges the circulation by compressing the heart and pulmonary vasculature. Our aim was to determine the amount of blood translocated from the central blood volume during GPI. Cardiac output and cardiac chamber volumes were assessed by magnetic resonance imaging in twelve breath-hold divers at rest and during apnea with GPI. Pulmonary blood volume was determined from pulmonary blood flow and transit times for gadolinium during first-pass perfusion after intravenous injection. During GPI, the lung volume increased by 0.8±0.6L (11±7%) above the total lung capacity. All cardiac chambers decreased in volume and despite a heart rate increase of 24±29 bpm (39±50%), pulmonary blood flow decreased by 2783±1820mL (43±20%). The pulmonary transit time remained unchanged at 7.5±2.2s and pulmonary blood volume decreased by 354±176mL (47±15%). In total, central blood volume decreased by 532±248mL (46±14%). Voluntary pulmonary hyperinflation leads to ∼50% decrease in pulmonary and central blood volume.
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Affiliation(s)
- Tanja Mijacika
- Dept. of Integrative Physiology, University of Split School of Medicine, Croatia
| | - Kasper Kyhl
- The Cardiac MRI group, Dept. Cardiology, Rigshospitalet, University of Copenhagen, Denmark
| | - Daria Frestad
- Dept. of Cardiology, Copenhagen University Hospital, Hvidovre, University of Copenhagen, Denmark
| | - F Otto Barak
- Dept. of Integrative Physiology, University of Split School of Medicine, Croatia; Dept. of Physiology, Faculty of Medicine, University of Novi Sad, Serbia
| | - Ivan Drvis
- University of Zagreb Faculty of Kinesiology, Croatia
| | - Niels H Secher
- Dept. of Anesthesiology, The Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Denmark
| | - Zeljko Dujic
- Dept. of Integrative Physiology, University of Split School of Medicine, Croatia.
| | - Per Lav Madsen
- Dept. of Cardiology, Copenhagen University Hospital, Herlev, University of Copenhagen, Denmark
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Mijacika T, Frestad D, Kyhl K, Barak O, Drvis I, Secher NH, Buca A, Obad A, Dujic Z, Madsen PL. Blood pooling in extrathoracic veins after glossopharyngeal insufflation. Eur J Appl Physiol 2017; 117:641-649. [PMID: 28243777 DOI: 10.1007/s00421-017-3545-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Trained breath-hold divers hyperinflate their lungs by glossopharyngeal insufflation (GPI) to prolong submersion time and withstand lung collapse at depths. Pulmonary hyperinflation leads to profound hemodynamic changes. METHODS Thirteen divers performed preparatory breath-holds followed by apnea with GPI. Filling of extrathoracic veins was determined by ultrasound and magnetic resonance imaging and peripheral extravasation of fluid was assessed by electrical impedance. Femoral vein diameter was measured by ultrasound throughout the easy-going and struggle phase of apnea with GPI in eight divers in a sub-study. RESULTS After GPI, pulmonary volume increased by 0.8 ± 0.6 L above total lung capacity. The diameter of the superior caval (by 36 ± 17%) and intrathoracic part of the inferior caval vein decreased (by 21 ± 16%), while the diameters of the internal jugular (by 53 ± 34%), hepatic (by 28 ± 40%), abdominal part of the inferior caval (by 28 ± 28%), and femoral veins (by 65 ± 50%) all increased (P < 0.05). Blood volume of the internal jugular, the hepatic, the abdominal part of the inferior caval vein, and the combined common iliac and femoral veins increased by 145 ± 115, 80 ± 88, 61 ± 60, and 183 ± 197%, respectively. In the sub-study, femoral vein diameter increased by 44 ± 33% in the easy-going phase of apnea with GPI, subsequently decreasing by 20 ± 16% during the struggle phase. Electrical impedance remained unchanged over the thigh and forearm, thus excluding peripheral fluid extravasation. CONCLUSIONS GPI leads to heart and pulmonary vessel compression, resulting in redistribution of blood to extrathoracic capacitance veins proximal to venous valves. This is partially reversed by the onset of involuntary breathing movements.
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Affiliation(s)
- Tanja Mijacika
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Daria Frestad
- Department of Cardiology, Copenhagen University Hospital, Hvidovre, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Kyhl
- The Cardiac MRI Group, Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Otto Barak
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.,Department of Physiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Ivan Drvis
- University of Zagreb School of Kinesiology, Zagreb, Croatia
| | - Niels H Secher
- Department of Anesthesiology, The Copenhagen Muscle Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ante Buca
- Department of Radiology, University Hospital Center, Split, Croatia
| | - Ante Obad
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Zeljko Dujic
- Department of Integrative Physiology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital, Herlev, University of Copenhagen, Copenhagen, Denmark
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Oh YJ, Jung JY, Kim SS, Chae KS, Rhu J, Lee C. The association of kidney function with repetitive breath-hold diving activities of female divers from Korea, Haenyeo. BMC Nephrol 2017; 18:75. [PMID: 28228118 PMCID: PMC5322595 DOI: 10.1186/s12882-017-0481-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/09/2017] [Indexed: 02/04/2023] Open
Abstract
Background Voluntary apnea during breath-hold diving (BHD) induces cardiovascular changes including bradycardia, reduced cardiac output, and arterial hypertension. Although the impacts of repetitive BHD on cardiovascular health have been studied previously, the long-term risk for kidney dysfunction has never been investigated. Methods A cross-sectional propensity score-matched study was performed to evaluate the influence of repetitive long-lasting BHD on kidney function. Using matching propensity scores (PS), 715 breath-hold female divers (Haenyeo) and non-divers were selected for analysis from 1,938 female divers and 3,415 non-divers, respectively. The prevalence of chronic kidney disease (CKD) defined as an estimated glomerular filtration rate (eGFR) calculated to be less than 60 ml/min/1.73 m2 was investigated in both diver and non-diver groups. Results The prevalence of CKD was significantly higher in breath-hold divers compared with non-divers after PS matching (12.6% vs. 8.0%, P = 0.004). In multivariate analysis, BHD activity was significantly associated with the risk of CKD in an unmatched cohort (OR, 1.976; 95% CI, 1.465–2.664). In the PS-matched cohort, BHD remained the independent risk factor for CKD even after adjusting for multiple covariates (OR 1.967; 95% CI, 1.341–2.886). Conclusion Shallow but repetitive intermittent apnea by BHD, sustained for a long period of time, may potentially cause a deterioration in kidney function, as a long-term consequence. Electronic supplementary material The online version of this article (doi:10.1186/s12882-017-0481-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yun Jung Oh
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea.,Department of Internal Medicine, Gachon University Graduate School of Medicine, Incheon, Korea
| | - Ji Yong Jung
- Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea.,Department of Internal Medicine, Division of Nephrology, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Soo Kim
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea
| | - Kyong-Suk Chae
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea
| | - Jiwon Rhu
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea
| | - Chungsik Lee
- Department of Internal Medicine, Cheju Halla General Hospital, Doryeong-ro 65, Jeju, 63127, Korea.
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Lippmann J, Lawrence C, Fock A, Jamieson S, Harris R. Provisional report on diving-related fatalities in Australian waters in 2011. Diving Hyperb Med 2016; 46:207-240. [PMID: 27966202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION An individual case review of diving-related deaths reported as occurring in Australia in 2011 was conducted as part of the DAN Asia-Pacific dive fatality reporting project. METHOD The case studies were compiled using reports from witnesses, the police and coroners. In each case, the particular circumstances of the accident and, where available, details from the post-mortem examination are provided. A chain of events analysis was conducted for each case. RESULTS In total, there were 30 reported fatalities (10 more than in 2010). These included 15 snorkel/breath-hold divers, 14 scuba divers and one diver using surface-supplied breathing apparatus. Twenty-four victims were males. The mean age of snorkelling victims was 49.6 (range 23-75) years and compressed gas divers 42.2 (range 23-55) years. Cardiac-related issues were thought to have been the disabling injury in the deaths of at least seven snorkel divers and five scuba divers. Immersion pulmonary oedema was implicated in at least one death; and three fatalities resulted from attacks by marine animals. Two novices died while under instruction/supervision after separation from their instructor in poor visibility. CONCLUSIONS Pre-existing medical conditions, separation and inadequate supervision and seafood collection in areas frequented by marine predators were once again features in several deaths in this series.
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Affiliation(s)
- John Lippmann
- Divers Alert Network (DAN) Asia-Pacific, Ashburton, Victoria, Australia
- Deakin University, Victoria, Australia
- PO Box 384, Ashburton VIC 3147, Australia.
| | | | - Andrew Fock
- Departments of Hyperbaric Medicine and Intensive Care Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Scott Jamieson
- Divers Alert Network (DAN) Asia-Pacific, Ashburton, Victoria, Australia
| | - Richard Harris
- Department of Diving and Hyperbaric Medicine, Royal Adelaide Hospital, South Australia. Australia
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31
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Del Castillo Velasco-Martínez I, Hernández-Camacho CJ, Méndez-Rodríguez LC, Zenteno-Savín T. Purine metabolism in response to hypoxic conditions associated with breath-hold diving and exercise in erythrocytes and plasma from bottlenose dolphins (Tursiops truncatus). Comp Biochem Physiol A Mol Integr Physiol 2015; 191:196-201. [PMID: 26506131 DOI: 10.1016/j.cbpa.2015.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
Abstract
In mammalian tissues under hypoxic conditions, ATP degradation results in accumulation of purine metabolites. During exercise, muscle energetic demand increases and oxygen consumption can exceed its supply. During breath-hold diving, oxygen supply is reduced and, although oxygen utilization is regulated by bradycardia (low heart rate) and peripheral vasoconstriction, tissues with low blood flow (ischemia) may become hypoxic. The goal of this study was to evaluate potential differences in the circulating levels of purine metabolism components between diving and exercise in bottlenose dolphins (Tursiops truncatus). Blood samples were taken from captive dolphins following a swimming routine (n=8) and after a 2min dive (n=8). Activity of enzymes involved in purine metabolism (hypoxanthine guanine phosphoribosyl transferase (HGPRT), inosine monophosphate deshydrogenase (IMPDH), xanthine oxidase (XO), purine nucleoside phosphorylase (PNP)), and purine metabolite (hypoxanthine (HX), xanthine (X), uric acid (UA), inosine monophosphate (IMP), inosine, nicotinamide adenine dinucleotide (NAD(+)), adenosine, adenosine monophosphate (AMP), adenosine diphosphate (ADP), ATP, guanosine diphosphate (GDP), guanosine triphosphate (GTP)) concentrations were quantified in erythrocyte and plasma samples. Enzymatic activity and purine metabolite concentrations involved in purine synthesis and degradation, were not significantly different between diving and exercise. Plasma adenosine concentration was higher after diving than exercise (p=0.03); this may be related to dive-induced ischemia. In erythrocytes, HGPRT activity was higher after diving than exercise (p=0.007), suggesting an increased capacity for purine recycling and ATP synthesis from IMP in ischemic tissues of bottlenose dolphins during diving. Purine recycling and physiological adaptations may maintain the ATP concentrations in bottlenose dolphins after diving and exercise.
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Affiliation(s)
- Iris Del Castillo Velasco-Martínez
- Centro de Investigaciones Biológicas del Noroeste, S.C., Programa de Planeación Ambiental y Conservación, Instituto Politécnico Nacional 195, Playa Palo Santa Rita Sur, La Paz, Baja California Sur C.P. 23096, México.
| | - Claudia J Hernández-Camacho
- Centro Interdisciplinario de Ciencias Marinas-Instituto Politécnico Nacional, Laboratorio de Ecología de Pinnípedos, Av. Instituto Politécnico Nacional s/n, Playa Palo Santa Rita, La Paz, Baja California Sur C.P. 23096, México.
| | - Lía C Méndez-Rodríguez
- Centro de Investigaciones Biológicas del Noroeste, S.C., Programa de Planeación Ambiental y Conservación, Instituto Politécnico Nacional 195, Playa Palo Santa Rita Sur, La Paz, Baja California Sur C.P. 23096, México.
| | - Tania Zenteno-Savín
- Centro de Investigaciones Biológicas del Noroeste, S.C., Programa de Planeación Ambiental y Conservación, Instituto Politécnico Nacional 195, Playa Palo Santa Rita Sur, La Paz, Baja California Sur C.P. 23096, México.
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Schipke JD, Siegmund K, Taher A, Krüll M, Cleveland S, Kelm M, Steiner S. Loss of consciousness via oculocardiac reflex during deep breath-hold diving. A case report. Int J Cardiol 2015; 193:56-7. [PMID: 26005177 DOI: 10.1016/j.ijcard.2015.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 05/09/2015] [Indexed: 11/24/2022]
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Toklu AS, Erelel M, Arslan A. Pneumomediastinum or lung damage in breath-hold divers from different mechanisms: a report of three cases. Diving Hyperb Med 2013; 43:232-235. [PMID: 24510331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 10/20/2013] [Indexed: 06/03/2023]
Abstract
Normally pulmonary over-inflation is not an issue during breath-hold diving, in contrast to lung squeeze. Compared with compressed air diving, pulmonary barotrauma is rare in breath-hold diving. Several mechanisms can lead to an increase in intrathoracic pressure in breath-hold diving that may cause alveolar rupture. Here we report three cases of pulmonary barotrauma in breath-hold diving. Using high-resolution chest tomography, bullous damage in Case 1, and pneumomediastinum in Cases 2 and 3 were detected. Transient neurological symptoms in Cases 1 and 2 suggested cerebral arterial gas embolism. The mechanisms that caused intrapulmonary overpressure were, respectively, lung packing ('buccal pumping'), considerable effort and straining at depth, and breathing compressed air at depth and ascending without exhaling. All three cases recovered without specific treatment such as recompression.
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Affiliation(s)
- Akin Savaş Toklu
- Director, Department of Underwater and Hyperbaric Medicine, Istanbul University, İstanbul Faculty of Medicine, 34093, Fatih/Istanbul, Turkey, Phone: +90-(0)532-412-5168, Fax: +90-(0)212-414-2032, E-mail:
| | - Mustafa Erelel
- Lecturer at the Department of Pulmonary Diseases, Istanbul, University, Istanbul Faculty of Medicine, Istanbul
| | - Abdullah Arslan
- Resident at the Departments of Underwater and Hyperbaric Medicine
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Laitila M, Eskola V. Spontaneous pneumomediastinum in an 11-year-old boy after a shallow breath-hold dive. Diving Hyperb Med 2013; 43:235-236. [PMID: 24510332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/30/2013] [Indexed: 06/03/2023]
Abstract
Spontaneous pneumomediastinum is caused by pulmonary barotrauma due to transiently increased intra-alveolar and intra-bronchial pressure. The most frequent triggers of spontaneous pneumomediastinum in children are asthma and manoeuvres creating forced expiration. It has been rarely associated with breath-hold diving. Chest pain and dyspnoea are the main symptoms, and the diagnosis can be confirmed by chest X-ray. The treatment of choice is oxygen, analgesics and monitoring the patient. The recurrence rate is low. The main differential diagnoses of spontaneous pneumomediastinum are oesophageal perforation and pericarditis. We report a case of an 11-year-old boy with no substantial medical history, who tried to breath-hold in shallow water for as long as possible. After diving, he felt dyspnoea and chest pain. Chest X-ray revealed pneumomediastinum and subcutaneous emphysema. The patient was admitted to the PICU for observation and was discharged after two days' follow up. Spontaneous pneumomediastinum in children may be more common than thus far acknowledged. It requires a high index of suspicion and should be considered in all children with acute chest pain.
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Affiliation(s)
- Maija Laitila
- Department of Pediatrics, Tampere University Hospital, Finland
| | - Vesa Eskola
- Department of Pediatrics, Tampere University Hospital, PB 2000, 33521 Tampere, Finland, Phone: +35-(0)83-3116-5702, Fax: +35-(0)83-3116-4435, E-mail:
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35
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Gempp E, Sbardella F, Cardinale M, Louge P. Pulmonary oedema in breath-hold diving: an unusual presentation and computed tomography findings. Diving Hyperb Med 2013; 43:162-163. [PMID: 24122192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 06/16/2013] [Indexed: 06/02/2023]
Abstract
Haemoptysis and pulmonary oedema following deep breath-hold diving have been described in recent years. We describe the case of a 33-year-old healthy military diver who presented symptoms suggestive of pulmonary oedema after two breathhold dives, the first lasting 0.5-1 min and the second 1-2 min, to 6 metres' depth in the sea. The diagnosis was promptly confirmed with chest computed tomography showing bilateral interstitial infiltrates in the upper regions of the lungs. To our knowledge, this is the first report to document pulmonary oedema in this setting of shallow breath-hold diving with atypical radiological presentation. A definite mechanism for this specific distribution of lung injury remains unclear.
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Affiliation(s)
- Emmanuel Gempp
- Sainte Anne's Military Hospital, Department of Diving and Hyperbaric Medicine, BP 600 83800 Toulon cedex 9, France, Phone/Fax: +33-(0)4-8316-2320, E-mail:
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Marabotti C, Piaggi P, Menicucci D, Passera M, Benassi A, Bedini R, L'Abbate A. Cardiac function and oxygen saturation during maximal breath-holding in air and during whole-body surface immersion. Diving Hyperb Med 2013; 43:131-137. [PMID: 24122187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 07/08/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION The magnitude of the oxygen-sparing effect induced by the diving response in humans is still under debate. We wished to compare cardiovascular changes during maximal breath-holding (BH) in air and during whole-body immersion at the surface in a group of BH divers. METHODS Twenty-one divers performed a maximal static apnea in air or during whole-body immersion. Dopplerechocardiography, arterial blood pressure and haemoglobin saturation (SaO₂) were obtained at the beginning of, and at 1/3, 2/3 and maximal BH time. RESULTS BH time was on the average 3.6 ± 0.4 min, with no differences between the two conditions. SaO₂ significantly decreased during BH in both conditions, but was significantly higher during immersion as compared to the dry (P = 0.04). In both conditions, BH induced a significant linear increase in right ventricular diameter (P < 0.001), left ventricular (LV) volumes (P < 0.001) and LV stroke volume (P < 0.001) but a significant linear decrease in LV ejection fraction (P = 0.033). In both conditions, Doppler diastolic parameters showed changes suggesting a constrictive/restrictive left ventricular filling pattern (i.e., an increase of early diastolic left ventricular filling velocity, P = 0.005, and a decrease in the deceleration time of early diastolic left ventricular filling. P < 0.001). CONCLUSION BH induces progressive LV enlargement both in air and whole-body immersion, associated with reduced LV ejection fraction and progressive hindrance to diastolic filling. For a similar apnea duration, SaO₂ decreased less during immersed BH, indicating an O₂-sparing effect of diving, suggesting that interruption of apnea was not triggered by a threshold critical value of blood O₂ desaturation.
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Affiliation(s)
- Claudio Marabotti
- CNR Institute of Clinical Physiology, EXTREME Center, Scuola Superiore Sant' Anna, Piazza Martiri della Libertà 33, 56127 Pisa, Italy, Phone: +39-(0)47-335-7368, Fax: +39-(0)58-661-4268, E-mail: c.marabotti@alice
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