2023 March;53(1) 

Diving Hyperb Med. 2023 March 31;53(1):2−6. doi: 10.28920/dhm53.1.2-6. PMID: 36966516.

Effects of external bleeding and hyperbaric oxygen treatment on Tamai zone 1 replantation

Yavuz Tuluy1, Alper Aksoy2, Emin Sır3

1 Department of Plastic Reconstructive and Aesthetic Surgery, Turgutlu State Hospital, Manisa, Turkey
2 Konur Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Bursa, Turkey
3 İzmir Kavram Vocational School, Department of Plastic Reconstructive and Aesthetic Surgery, İzmir, Turkey

Corresponding author: Dr Yavuz Tuluy, Plastic, Reconstructive and Aesthetic Surgery, Manisa Turgutlu State Hospital, Turgutlu, Manisa, 45000, Turkey
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Keywords
Finger; Microsurgery; Reperfusion; Surgery

Abstract
(Tuluy Y, Aksoy A, Sir E. Effects of external bleeding and hyperbaric oxygen treatment on Tamai zone 1 replantation. Diving and Hyperbaric Medicine. 2023 March 31;53(1):2−6. doi: 10.28920/dhm53.1.2-6. PMID: 36966516.)
Introduction: Tamai zone 1 replantation poses a challenge due to the very small size of the vascular structures; often there is no vein for anastomosis. Replantation may have to be done with only an arterial anastomosis. In our study, we aimed to evaluate the success of replantation by combining external bleeding and hyperbaric oxygen treatment (HBOT) in Tamai zone 1 replantation.
Methods: Between January 2017 and October 2021, 17 finger replantation patients who underwent artery-only anastomosis due to Tamai zone 1 amputation received 20 sessions of HBOT with external bleeding after the 24th postoperative hour. Finger viability was assessed at the end of treatment. A retrospective review of outcomes was performed.
Results: Seventeen clean-cut finger amputation patients were operated on under digital block anesthesia with a finger tourniquet. No blood transfusion was required. In one patient, complete necrosis developed and stump closure was performed. Partial necrosis was observed in three patients and healed secondarily. Replantation in the remaining patients was successful.
Conclusions: Vein anastomosis is not always possible in fingertip replantation. In Tamai zone 1 replantation with artery-only anastomosis, post-operative HBOT with induced external bleeding appeared to shorten the hospital stay and was associated with a high proportion of successful outcomes.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article

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Diving Hyperb Med. 2023 March 31;53(1):7−15. doi: 10.28920/dhm53.1.7-15. PMID: 36966517.

A review of 149 Divers Alert Network emergency call records involving diving minors

Elizabeth T Helfrich1, Camilo M Saraiva1, James M Chimiak1, Matias Nochetto1

1 Divers Alert Network, Durham (NC), USA

Corresponding author: Dr Matias Nochetto, Vice President, Medical Services, Divers Alert Network, Durham NC, USA
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Keywords
Arterial gas embolism; Children; Decompression illness; Pulmonary barotrauma; Scuba diving

Abstract
(Helfrich ET, Saraiva CM, Chimiak JM, Nochetto M. A review of 149 Divers Alert Network emergency call records involving diving minors. Diving and Hyperbaric Medicine. 2023 March 31;53(1):7−15. doi: 10.28920/dhm53.1.7-15. PMID: 36966517.)
Introduction: Minors have been scuba diving for decades, and while the initial concerns about potential long-term complications related to bone development appear to be unfounded, the incidence of scuba diving injuries among them has been poorly studied.
Methods: We reviewed 10,159 cases recorded in the DAN Medical Services call center database from 2014 through 2016 and identified 149 cases of injured divers younger than 18 years. Records were analysed for case categorisation on the most common dive injuries. Information about demographics, level of training, risk factors, and relevant behavioural aspects were collected when available.
Results: While the most common reason for the call was to rule out decompression sickness, the majority of cases pertained to ear and sinus issues. However, 15% of the dive-related injuries involving minors had a final diagnosis of pulmonary barotrauma (PBt). While no reliable data is available on the incidence of PBt in adult divers, the authors’ impression based on personal experience suggests that the number of cases of PBt in minors trends higher than in the general diving population. The narratives on some relevant records describe unmanageable levels of anxiety leading to panic.
Conclusions: Based on the results and narratives on these cases, it is reasonable to infer that psychological immaturity, suboptimal management of adverse situations, and inadequate supervision might have led to severe injuries among these minor divers.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article

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Diving Hyperb Med. 2023 March 31;53(1):16–23. doi: 10.28920/dhm53.1.16-23. PMID: 36966518.

Underwater pulse oximetry reveals increased rate of arterial oxygen desaturation across repeated freedives to 11 metres of freshwater

Eric Mulder1, Arne Sieber1,2, Chris McKnight3, Erika Schagatay1,4

1 Environmental Physiology Group, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
2 OXYGEN Scientific GmbH, Feldkirchen, Austria
3 Sea Mammal Research Unit, Scottish Oceans Institute, University of St Andrews, St Andrews, Scotland
4 Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden

Corresponding author: Eric Mulder, Mid Sweden University, Kunskapens väg 8, 83125 Östersund, Sweden
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Keywords
Breath-hold diving; Diving reflex; Hypoxia; Oxygen consumption; Safety; Unconsciousness

Abstract
(Mulder E, Sieber A, McKnight C, Shagatay E. Underwater pulse oximetry reveals increased rate of arterial oxygen desaturation across repeated freedives to 11 metres of freshwater. Diving and Hyperbaric Medicine. 2023 March 31;53(1):16−23. doi: 10.28920/dhm53.1.16-23. PMID: 36966518.)
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 20s 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.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article

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Diving Hyperb Med. 2023 March 31;53(1):24−30. doi: 10.28920/dhm53.1.24-30. PMID: 36966519.

Intraindividual variability of the Eustachian tube function: a longitudinal study in a pressure chamber

Nele Peters1*, Stefanie Jansen1*, Jens P Klußmann1, Moritz F Meyer2

1 Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
2 Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany
* Contributed equally to this work

Corresponding author: Dr Moritz F Meyer, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
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Keywords
Diving; Ear barotrauma; Ears; Middle ear; Pressure equalisation

Abstract
(Peters N, Jansen S, Klußmann JP, Meyer MF. Intraindividual variability of the Eustachian tube function: a longitudinal study in a pressure chamber. Diving and Hyperbaric Medicine. 2023 March 31;53(1):24−30. doi: 10.28920/dhm53.1.24-30. PMID: 36966519.)
Introduction: The Eustachian tube (ET) is essential for fast and direct pressure equalisation between middle ear and ambient pressure. It is not yet known to what extent Eustachian tube function in healthy adults changes in a weekly periodicity due to internal and external factors. This question is particularly interesting with regard to scuba divers among whom there is a need to evaluate intraindividual ET function variability.
Methods: Continuous impedance measurement in a pressure chamber was performed three times at one-week intervals between measurements. Twenty healthy participants (40 ears) were enrolled. Using a monoplace hyperbaric chamber, individual subjects were exposed to a standardised pressure profile consisting of a 20 kPa decompression over 1 min, a 40 kPa compression over 2 min, and a 20 kPa decompression over 1 min. Measurements of Eustachian tube opening pressure (ETOP), opening duration (ETOD), and opening frequency (ETOF) were made. Intraindividual variability was assessed.
Results: Mean ETOD during compression (actively induced pressure equalisation) on the right side was 273.8 (SD 158.8) ms, 259.4 (157.7) ms, and 249.2 (154.1) (Chi-square 7.30, P = 0.026) across weeks 1−3. Mean ETOD for both sides was 265.6 (153.3) ms, 256.1 (154.6) ms, and 245.7 (147.8) (Chi-square10.00, P = 0.007) across weeks 1−3. There were no other significant differences in ETOD, ETOP and ETOF across the three weekly measurements.
Conclusions: This longitudinal study suggests low week-to-week intraindividual variability of Eustachian tube function.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Original article

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Diving Hyperb Med. 2023 March 31;53(1):31−41. doi: 10.28920/dhm53.1.31-41. PMID: 36966520. PMCID: PMC10106275.

The risk of decompression illness in breath-hold divers: a systematic review

S Lesley Blogg1, Frauke Tillmans2, Peter Lindholm3

1 SLB Consulting, Newbiggin-on-Lune, Cumbria, UK
2 Divers Alert Network, Durham, USA
3 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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Keywords
Arterial gas embolism; Breath-hold diving; Decompression sickness; Diving; Freediving; Snorkelling; Spearfishing

Abstract
(Blogg SL, Tillmans F, Lindholm P. The risk of decompression illness in breath-hold divers: a systematic review. Diving and Hyperbaric Medicine. 2023 March 31;53(1):31−41. doi: 10.28920/dhm53.1.31-41. PMID: 36966520. PMCID: PMC10106275.)
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 decompression illness 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.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Review article

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Diving Hyperb Med. 2023 March 31;53(1):42−50. doi: 10.28920/dhm53.1.42-50. PMID: 36966521.

Safety and performance of intravenous pumps and syringe drivers in hyperbaric environments

Aisha Al Balushi1,2, David Smart2

1 National Hyperbaric Medicine Centre, Royal Hospital, Muscat, Sultanate of Oman
2 Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia

Corresponding author: Dr Aisha Al Balushi, Diving and Hyperbaric Medicine Fellow, National Hyperbaric Medicine Centre, Royal Hospital, Ghala St, Muscat, Sultanate of Oman
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Keywords
Equipment; Fire risk; Hyperbaric oxygen; Infusion devices; Safety; Risk assessment

Abstract
(Al Balushi A, Smart D. Safety and performance of intravenous pumps and syringe drivers in hyperbaric environments. Diving and Hyperbaric Medicine. 2023 March 31;53(1):42−50. doi: 10.28920/dhm53.1.42-50. PMID: 36966521.)
Introduction: Critically ill patients require continuation of their care when receiving hyperbaric oxygen treatment. This care may be facilitated via portable electrically powered devices such as intravenous (IV) infusion pumps and syringe drivers, which may create risks in the absence of a comprehensive safety evaluation. We reviewed published safety data for IV infusion pumps and powered syringe drivers in hyperbaric environments and compared the evaluation processes to key requirements documented in safety standards and guidelines.
Methods: A systematic literature review was undertaken to identify English language papers published in the last 15 years, describing the safety evaluations of IV pumps and/or syringe drivers for use in hyperbaric environments. Papers were critically assessed in relation to the requirements of international standards and safety recommendations.
Results: Eight studies of IV infusion devices were identified. There were deficiencies in the published safety evaluations of IV pumps for hyperbaric use. Despite a simple, published process for evaluating new devices, and available guidelines for fire safety, only two devices had comprehensive safety assessments. Most studies focused only on whether the device functioned normally under pressure and did not consider implosion/explosion risk, fire safety, toxicity, oxygen compatibility or risk of pressure damage.
Conclusions: Intravenous infusion (and other electrically powered) devices require comprehensive assessment before use under hyperbaric conditions. This would be enhanced by a publicly accessible database hosting the risk assessments. Facilities should conduct their own assessments specific to their environment and practices.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Review article

Full article available here.


Diving Hyperb Med. 2023 March 31;53(1):51–54. doi: 10.28920/dhm53.1.51-54. PMID: 36966522.

Validation of sham treatment in hyperbaric medicine: a randomised trial

Pierre Louge1, Rodrigue Pignel1, Jacques Serratrice2, Jerome Stirnemann2

1 Diving and hyperbaric Unit, University hospitals of Geneva, Geneva, Switzerland
2 Department of medicine, General Internal Medicine Service, University hospitals of Geneva, Geneva, Switzerland

Corresponding author: Dr Pierre Louge, Diving and hyperbaric Unit, University hospitals of Geneva, Geneva, Switzerland
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Keywords
Blinding; Hyperbaric research; Placebo; Research methods

Abstract
(Louge P, Pignel R, Serratrice J, Stirnemann J. Validation of sham treatment in hyperbaric medicine: a randomised trial. Diving and Hyperbaric Medicine. 2023 March 31;53(1):51–54. doi: 10.28920/dhm53.1.51-54. PMID: 36966522.)
Introduction: This study aimed to determine the lowest possible atmospheric pressure in the 111−152 kPa (1.1−1.5 atmospheres absolute [atm abs]) range that would require the patients to equalise their ears, allowing an effective sham for a 203 kPa (2.0 atm abs) hyperbaric exposure.
Methods: We performed a randomised controlled study on 60 volunteers divided into 3 groups (compression to 111, 132 and 152 kPa (1.1, 1.3, 1.5 atm abs) to determine the minimum pressure to obtain blinding. Secondly, we applied confounding factors (faster compression with ventilation during the fictitious compression time, heating at compression, cooling at decompression) on 25 new volunteers in order to enhance blinding.
Results: The number of participants who did not believe they had been compressed to 203 kPa was significantly higher in the 111 kPa compressed arm than in the other two arms (11/18 vs 5/19 and 4/18 respectively; P = 0.049 and P = 0.041, Fisher’s exact test). There was no difference between compressions to 132 and 152 kPa. By applying additional confounding factors, the number of participants who believed they had been compressed to 203 kPa increased to 86.5 %.
Conclusions: A compression to 132 kPa, (1.3 atm abs, 3 metres of seawater equivalent) combined with the confounding elements of forced ventilation, enclosure heating and compression in five minutes, simulates a therapeutic compression table and can be used as a hyperbaric placebo.

Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.

Publication Type: Short communication

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