Diving and hyperbaric medicine最新文献

{"title":"Review of excursion procedures used in commercial heliox saturation diving.","authors":"Jean-Pierre Imbert, Lyubisa Matity, Jean-Yves Massimelli, Christian Cadieux, Jan Risberg, Philip Bryson","doi":"10.28920/dhm56.1.21-40","DOIUrl":"10.28920/dhm56.1.21-40","url":null,"abstract":"<p><strong>Introduction: </strong>This study reviews heliox saturation procedures used in offshore commercial diving and focuses on bell excursion dives. It excludes initial compression and final decompression. Our first objective was to trace the history and the reasons behind the successive changes that led to the current practice. Our second objective was to review the current practice and identify problem areas and perspectives.</p><p><strong>Methods: </strong>We first present the background of excursion diving and reference key procedures from the US Navy, Comex, and international standards. We then review the procedures of 13 anonymised diving companies and compare their sources, designs, and operation parameters.</p><p><strong>Results: </strong>The current excursion procedures are derived from a few original procedures (US Navy, Comex). It appears that, without relevant scientific support since the 1980s, companies have empirically adapted these procedures to their needs. Two designs prevail: excursions from storage depth and excursions from the deepest depth. Recent innovations offer 'standard' and 'extended' excursions, sliding excursion windows, as well as shallow and deep excursions. Companies participating in the study have a low risk of DCS with excursion diving. Excursions rarely produce immediate DCS symptoms but associated bubble formation could impact the final decompression. The trend is towards reduced excursion distances and explicit post-excursion intervals. Oxygen toxicity remains a general concern in saturation diving, but the PO₂ values used in the procedures reviewed are unlikely to cause pulmonary toxicity according to the dose models in use.</p><p><strong>Conclusions: </strong>We observed a trend towards harmonisation under the pressure of international standards and through cooperation within industry association committees. We recommend scientific monitoring of saturation divers to measure the decompression stress and support further research and development. We recommend that companies document their procedural developments to record and thus keep the lessons learned.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"56 1","pages":"21-40"},"PeriodicalIF":1.1,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13095488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cutaneous decompression sickness after an air dive with oxygen breathed during decompression in a commercial diver with a persistent foramen ovale.","authors":"Peter Wilmshurst, Timothy Griffiths, Nigel Stokes, Grant Heatlie","doi":"10.28920/dhm55.4.427-429","DOIUrl":"10.28920/dhm55.4.427-429","url":null,"abstract":"<p><p>A 43-year-old commercial diver had cutaneous decompression sickness after a dive to 17 metres of seawater for 160 minutes breathing air with transfer under pressure and oxygen breathed during decompression in a dry chamber. He had worked as a commercial diver for 16 years without previous problems. A bubble contrast transthoracic echocardiogram showed a large atrial right-to-left shunt. His persistent foramen ovale (PFO) was closed using a transcatheter technique and he has returned to commercial diving. As far as we are aware, shunt-mediated decompression sickness has not been reported previously after a shallow air dive with oxygen breathed during decompression. The findings in this diver adds to the observation of occurrence of three episodes of cutaneous decompression sickness after dry hyperbaric exposure breathing air and decompression whilst breathing oxygen in two individuals with atrial right-to-left shunts.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 4","pages":"427-429"},"PeriodicalIF":1.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical flicker fusion frequency measurement through a chamber porthole.","authors":"Jochen D Schipke, Thomas Muth, Anne-Kathrin Brebeck, Sven Dreyer","doi":"10.28920/dhm55.4.419-422","DOIUrl":"10.28920/dhm55.4.419-422","url":null,"abstract":"<p><p>The critical flicker fusion frequency (cFFF) is a non-invasive measure of central nervous system function and cortical arousal, increasingly used in diving and hyperbaric medicine to assess the effects of breathing gases under pressure. This feasibility study aimed to evaluate whether cFFF can be reliably measured through the porthole of a hyperbaric chamber. Forty-five experienced male divers underwent cFFF testing at various pressures (101.3 kPa outside chamber, then 101.3, 608, 132, 101.3 kPa inside [1.0 bar outside then 1.0, 6.0, 1.3, 1.0 bar inside]) using a manually operated LED flicker-device while standing at a fixed distance from the chamber window. Results showed that cFFF values were higher inside the chamber at 101.3 kPa (1.0 bar) compared to outside (45.6 Hz vs. 40.2 Hz), decreased under hyperbaric conditions (608 kPa [6 bar], 43.5 Hz), and declined further during decompression (132 kPa [1.3 bar], 42.1 Hz; 101.3 kPa [1.0 bar], 43.5 Hz). These findings support previous observations of gas-induced central nervous system effects and highlight the sensitivity of cFFF to pressure-related neural changes. The successful external measurement protocol addresses challenges associated with observer narcosis and movement artifacts in underwater settings. While limited by the homogenous participant group and lack of confirmatory measures, this approach may still be a valuable tool for future research into the temporal dynamics of gas narcosis and cortical excitation.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 4","pages":"419-422"},"PeriodicalIF":1.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperbaric oxygen therapy as salvage treatment for post-traumatic sudden sensorineural hearing loss: a case report.","authors":"Luís André Baptista, Joana Guincho, Mariana Donato, Pedro Araújo, Carla Espiney Amaro, Pedro Alberto Escada","doi":"10.28920/dhm55.4.423-426","DOIUrl":"10.28920/dhm55.4.423-426","url":null,"abstract":"<p><strong>Introduction: </strong>We report the first case of hyperbaric oxygen therapy used to treat sensorineural hearing loss in a child after head trauma.</p><p><strong>Case report: </strong>A 13-year-old boy with no relevant past medical history presented to the emergency department with tinnitus and hypoacusia following head trauma. An ear computed tomography scan showed a right longitudinal temporal fracture sparing the otic capsule, and the audiogram identified a moderate sensorineural hearing loss in the right ear involving frequencies between 2,000 and 8,000 Hz. He was treated with corticosteroids and betahistine for an acute audiovestibular loss with resolution of the vestibular symptoms. At three months post-trauma the sensorineural hearing loss persisted. The patient started treatment with hyperbaric oxygen therapy with complete resolution of the hearing loss after 11 sessions.</p><p><strong>Conclusions: </strong>This case identifies potential benefit from salvage hyperbaric oxygen therapy in the treatment of sudden sensorineural hearing loss of traumatic etiology.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 4","pages":"423-426"},"PeriodicalIF":1.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of fluid loss on the physiology of closed-circuit rebreather divers after 100- and 45-metre dives.","authors":"Laura Tuominen, Richard Lundell, Costantino Balestra, Tomi Wuorimaa, Lauri Koponen, Sofia Sokolowski, Anne Räisänen-Sokolowski","doi":"10.28920/dhm55.4.391-397","DOIUrl":"10.28920/dhm55.4.391-397","url":null,"abstract":"<p><strong>Introduction: </strong>Diving induced immersion diuresis predisposes divers to dehydration. Dehydration is considered a risk factor for decompression sickness (DCS) but there is very little evidence to prove it. Dehydration also potentially modifies venous gas emboli (VGE) formation and impairs endothelial function. The purpose of this study was to report the effects of fluid loss during a dive on the diver's physiology.</p><p><strong>Methods: </strong>Nine divers performed a 45 metre fresh water (mfw) and a 100 mfw dive with predetermined dive profiles. Body weight was measured before and after the dive. Post-dive detection of VGE was performed according to the extended Eftedal-Brubakk scale. We also measured haematocrit and flow mediated dilation before and after the 100 mfw dives.</p><p><strong>Results: </strong>After a 68-minute dive to 45 mfw, median weight loss was -1.1 kg, (IQR -1.2, -1.0; range -2.0, -0.6), P = 0.009 and VGE were detected in all divers. After a 170-minute dive to 100 mfw, median weight loss was -1.5 kg (IQR -1.8, -1.1; range -2.2, -0.8), P = 0.009 and VGE were detected in seven divers. Weight loss after the dive was statistically significant and there was a negative correlation between weight loss and bubbling after the 45 mfw dives. None of the divers suffered any symptoms of DCS.</p><p><strong>Conclusions: </strong>We found significant weight loss after both decompression dives but there were no clinical DCS symptoms in any of the divers. This study does not offer new evidence supporting the notion that dehydration increases decompression stress in divers.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 4","pages":"391-397"},"PeriodicalIF":1.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation and clinical use of the Maquet (Getinge) original series Rotaflow extracorporeal membrane oxygenation device in hyperbaric conditions: a technical report.","authors":"Theo Tsouras, Bridget Devaney, Zhiliang Caleb Lin, Christopher Covelli, Lloyd Roberts, Vinodh Bhagyalakshmi Nanjayya, Ian Millar","doi":"10.28920/dhm55.4.323-329","DOIUrl":"10.28920/dhm55.4.323-329","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation (ECMO) has not been previously used clinically in the modern hyperbaric chamber. We describe the modifications, validation and clinical performance of the Maquet (Getinge) original series Rotaflow (Rotaflow 1), Quadrox-i adult microporous membrane oxygenator and permanent life support (PLS) circuit under hyperbaric conditions.</p><p><strong>Methods: </strong>A Rotaflow 1 and Quadrox oxygenator underwent power supply modifications and rigorous safety testing in the hyperbaric environment using a PLS circuit primed with normal saline. Clinical validation was subsequently undertaken during a 'last resort' course of 13 hyperbaric oxygen treatment (HBOT) sessions for a patient suffering a life threatening vaso-invasive fungal infection requiring support with venovenous ECMO.</p><p><strong>Results: </strong>Preliminary testing and subsequent clinical application in the hyperbaric chamber demonstrated steady flow through the circuit based on pump revolutions per minute, with up to 180 mL (10%) variability demonstrated between the console display compared to the independent flow meter. No significant changes to flow variability were noted during pressurisation and decompression phases. Device temperature remained within safe limits. No bubbles were visually or sonographically detected. There were no performance or integrity issues detected through compression, maintenance and decompression phases. During clinical use, the patient remained stable and hyperoxygenation targets were achieved. Membrane oxygenator oxygen inflow set at up to 8 L·min-1 maintained CO2 clearance.</p><p><strong>Conclusions: </strong>After safety related modifications to the console's power supply, the Rotaflow 1 console, Quadrox oxygenator and PLS circuit performed satisfactorily up to 243 kPa during repeated clinical use.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 4","pages":"323-329"},"PeriodicalIF":1.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12831603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary on the article by Stevens G, Smart DR. The influence of wetsuit thickness (≥ 7 mm) on lung volumes in scuba divers.","authors":"Jacques Regnard, Olivier Castagna","doi":"10.28920/dhm55.4.436-437","DOIUrl":"10.28920/dhm55.4.436-437","url":null,"abstract":"","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 4","pages":"436-437"},"PeriodicalIF":1.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of in-water recompression for decompression illness after deep freediving: a case series.","authors":"Nicole Lin, Elaine Yu, Anna Lussier, Emmanuel Gouin, Peter Lindholm","doi":"10.28920/dhm55.4.376-383","DOIUrl":"10.28920/dhm55.4.376-383","url":null,"abstract":"<p><strong>Introduction: </strong>There are increasing anecdotal reports of in-water recompression in freedivers who surface with neurological symptoms, likely suffering from decompression illness (DCI). Given the remote locations where many cases occurred, divers often struggled to access medical care, including the gold-standard hyperbaric oxygen treatment (HBOT), thus resorting to in-water recompression (IWR). Currently, IWR guidelines have only been discussed for scuba and surface supplied divers in specific scenarios, with protocols prescribing oxygen breathing at depths ≤ 9 metres maximum for around 1-3 hours.</p><p><strong>Methods: </strong>We conducted detailed interviews with six competitive freedivers on signs, symptoms, management, and resolution of 13 cases of DCI. We additionally requested records of medical evaluation and treatment, with their consent.</p><p><strong>Results: </strong>Three cases were suggestive of decompression sickness, six were consistent with arterial gas embolism, and four were ambiguous. Six cases were treated with IWR for 20-90 min at 5-25 metres with partial to complete resolution of symptoms. Four of these cases received HBOT afterwards. One diver reported significant permanent disability. Divers made several regimen changes after these incidents, including staying well-hydrated, reducing lung-packing, slowing their ascent rate, and/or employing prophylactic IWR when diving beyond a specified depth.</p><p><strong>Conclusions: </strong>Given the remote locations of many incidents, freedivers often faced challenges in accessing HBOT. Self-treatment with IWR was widely used, either as a bridge to HBOT or as a standalone remedy. IWR poses potential risks, especially at the deeper depths reported in this study. This treatment modality is being utilised sometimes without medical oversight and recommended guidelines for IWR for freedivers should be developed.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 4","pages":"376-383"},"PeriodicalIF":1.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12831604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decompression illness in breath-hold divers: insights from an online survey.","authors":"Elaine Yu, Nicole Lin, Peter Lindholm","doi":"10.28920/dhm55.4.384-390","DOIUrl":"10.28920/dhm55.4.384-390","url":null,"abstract":"<p><strong>Introduction: </strong>Breath-hold divers can surface with neurological symptoms consistent with nitrogen buildup in tissues or gas entry into the arterial circulation, collectively termed decompression illness (DCI). While DCI has historically been attributed to diving with compressed air, breath-hold divers have reported similar syndromes. The causes, diagnosis, and management of DCI in breath-hold divers is poorly understood.</p><p><strong>Methods: </strong>We developed an online survey that queried breath-hold divers on the symptoms they experienced during decompression illness events and the medical management of each event.</p><p><strong>Results: </strong>A total of 36 (31 M, 5 F) breath-hold divers filled out the survey. A majority identified as recreational freedivers, competitive freedivers, and/or spearfishers with an average age of 45 years and 18 years of breath-hold diving experience. Of those surveyed, 33 (92%) held a certification from an accredited training agency. A total of 18 (50%) reported experiencing DCI, with 21 DCI incidents reported by 13 individuals from 1999-2024. Sixteen (76%) of DCI incidents occurred during training, with an average depth of 83.4 m and average speed of 1.0 m∙s-1. Thirteen (62%) percent of DCI incidents occurred while diving to depths shallower than a previous personal best. The most common symptoms were weakness, numbness, slurred speech, and fatigue. The most common treatment modalities were surface oxygen, in-water recompression, and hyperbaric oxygen therapy. Sixteen divers (76%) had partial or complete resolution of their symptoms. The top cited contributors to the DCI incidents were depth, short surface interval between dives, and pulmonary barotrauma.</p><p><strong>Conclusions: </strong>Breath-hold divers can experience DCI even when diving within their limits. The most cited contributors to DCI were depth, short surface interval between dives, and pulmonary barotrauma. Most divers' symptoms resolved after treatment with surface oxygen, in-water recompression, and/or hyperbaric oxygen therapy.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 4","pages":"384-390"},"PeriodicalIF":1.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13102180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of reporting in hyperbaric medicine clinical trials: a cross-sectional study.","authors":"Yeonjung Yoo, Angélique Cléroux, Neal W Pollock, Sylvain Boet","doi":"10.28920/dhm55.4.352-368","DOIUrl":"10.28920/dhm55.4.352-368","url":null,"abstract":"<p><strong>Introduction: </strong>Research in hyperbaric oxygen (HBO) medicine is growing, but the quality of HBO studies is variable. Low study quality may compromise evidence-based decision-making and clinical translation.</p><p><strong>Methods: </strong>This cross-sectional study examined the adherence of 50 randomly selected HBO clinical trials (25 randomised controlled trials [RCTs] and 25 observational studies) to relevant core reporting guidelines: consolidated standards of reporting trials (CONSORT), non-pharmacologic treatments (NPT), and strengthening the reporting of observational studies in epidemiology (STROBE). Studies published in peer-reviewed journals between January 2018 and May 2023 and indexed on PubMed were analysed. Reporting quality was classified as 'excellent' (> 85% of guideline items adequately reported), 'good' (50-85%), or 'poor' (< 50%).</p><p><strong>Results: </strong>The sample represented 29% of RCTs and 16% of observational studies for the timeframe assessed. No study was rated as 'excellent' for completeness, 28 (56%) were rated as 'good', and 22 (44%) as 'poor'. In RCTs, only one study (4%) adequately reported protocol adherence and eight studies (32%) reported blinding procedures. The NPT checklist showed that key items, including care provider adherence (0 studies) and participant adherence (one study; 4%), were frequently not reported. For observational studies, basic design elements were adequately reported, but with significant gaps in bias management (nine studies; 36%) and missing data handling (13 studies; 52%). Only six studies (12%) mentioned the use of reporting guidelines.</p><p><strong>Conclusions: </strong>Our results showed that quality of reporting of HBO studies is suboptimal. These findings highlight the need for increased awareness and implementation of reporting guidelines, as well as the potential development of HBO-specific guidelines.</p>","PeriodicalId":11296,"journal":{"name":"Diving and hyperbaric medicine","volume":"55 4","pages":"352-368"},"PeriodicalIF":1.1,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13092552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}