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  • 1. Blogg, S. Lesley
    et al.
    Gennser, Mikael
    KTH, School of Technology and Health (STH), Basic Science and Biomedicine, Environmental Physiology.
    Møllerløkken, Andreas
    Brubakk, Alf O.
    Ultrasound detection of vascular decompression bubbles: the influence of new technology and considerations on bubble load2014In: Diving and Hyperbaric Medicine, ISSN 1833-3516, Vol. 44, no 1, p. 35-44Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Diving often causes the formation of 'silent' bubbles upon decompression. If the bubble load is high, then the risk of decompression sickness (DCS) and the number of bubbles that could cross to the arterial circulation via a pulmonary shunt or patent foramen ovale increase. Bubbles can be monitored aurally, with Doppler ultrasound, or visually, with two-dimensional (2D) ultrasound imaging. Doppler grades and imaging grades can be compared with good agreement. Early 2D imaging units did not provide such comprehensive observations as Doppler, but advances in technology have allowed development of improved, portable, relatively inexpensive units. Most now employ harmonic technology; it was suggested that this could allow previously undetectable bubbles to be observed. Methods: This paper provides a review of current methods of bubble measurement and how new technology may be changing our perceptions of the potential relationship of these measurements to decompression illness. Secondly, 69 paired ultrasound images were made using conventional 2D ultrasound imaging and harmonic imaging. Images were graded on the Eftedal-Brubakk (EB) scale and the percentage agreement of the images calculated. The distribution of mismatched grades was analysed. Results: Fifty-four of the 69 paired images had matching grades. There was no significant difference in the distribution of high or low EB grades for the mismatched pairs. Conclusions: Given the good level of agreement between pairs observed, it seems unlikely that harmonic technology is responsible for any perceived increase in observed bubble loads, but it is probable that our increasing use of 2D ultrasound to assess dive profiles is changing our perception of 'normal' venous and arterial bubble loads. Methods to accurately investigate the load and size of bubbles developed will be helpful in the future in determining DCS risk.

  • 2.
    Silvanius, Marten
    et al.
    Swedish Armed Forces, Diving & Naval Med Ctr, Karlskrona, Sweden.;Blekinge Inst Technol, Karlskrona, Sweden..
    Mitchell, Simon J.
    Univ Auckland, Dept Anaesthesiol, Auckland, New Zealand..
    Pollock, Neal W.
    Univ Laval Quebec, Dept Kinesiol, Quebec City, PQ, Canada..
    Franberg, Oskar
    Blekinge Inst Technol, Karlskrona, Sweden..
    Gennser, Mikael
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Environmental Physiology.
    Linden, Jerry
    Swedish Armed Forces, Diving & Naval Med Ctr, Karlskrona, Sweden..
    Mesley, Peter
    Lust Rust Diving Expedit, Auckland, New Zealand..
    Gant, Nicholas
    Univ Auckland, Dept Exercise Sci, Auckland, New Zealand..
    The performance of 'temperature stick' carbon dioxide absorbent monitors in diving rebreathers2019In: Diving and Hyperbaric Medicine, ISSN 1833-3516, Vol. 49, no 1, p. 48-56, article id PMID 30856667Article in journal (Refereed)
    Abstract [en]

    Introduction: Diving rebreathers use canisters containing soda lime to remove carbon dioxide (CO2) from expired gas. Soda lime has a finite ability to absorb CO2. Temperature sticks monitor the exothermic reaction between CO2 and soda lime to predict remaining absorptive capacity. The accuracy of these predictions was investigated in two rebreathers that utilise temperature sticks. Methods: Inspiration and rEvo rebreathers filled with new soda lime were immersed in water at 19 degrees C and operated on mechanical circuits whose ventilation and CO2-addition parameters simulated dives involving either moderate exercise (6 MET) throughout (mod-ex), or 90 minutes of 6 MET exercise followed by 2 MET exercise (low-ex) until breakthrough (inspired PCO2 [PiCO2] = 1 kPa). Simulated dives were conducted at surface pressure (sea-level) (low-ex: Inspiration, n = 5; rEvo, n = 5; mod-ex: Inspiration, n = 7, rEvo, n = 5) and at 3-6 metres' sea water (msw) depth (mod-ex protocol only: Inspiration, n = 8; rEvo, n = 5). Results: Operated at surface pressure, both rebreathers warned appropriately in four o five low-ex tests but failed to do so in the 12 mod-ex tests. At 3-6 msw depth, warnings preceded breakthrough in 11 of 13 mod-ex tests. The rEvo warned conservatively in all five tests (approximately 60 minutes prior). Inspiration warnings immediately preceded breakthrough in six of eight tests, but were marginally late in one test and 13 minutes late in another. Conclusion: When operated at even shallow depth, temperature sticks provided timely warning of significant CO2 breakthrough in the scenarios examined. They are much less accurate during simulated exercise at surface pressure.

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