Arterial Blood Gases During Diving in Elite Apnea Divers

Muth, Claus-Martin; Radermacher, Peter; Pittner, Antje; Steinacker, Jürgen M.; Schabana, R.; Hamich, S.; Paulat, Klaus; Calzia, Enrico

doi:10.1055/s-2003-38401

Cited by 47 publications

(50 citation statements)

References 14 publications

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“…Competitive breath-hold divers are exceptional in this regard; in the practice of their sport, they achieve extraordinarily large and small lung volumes. Before each dive, they inhale to maximal lung volume (total lung capacity, TLC) and then employ glossopharyngeal insufflation (GI), which is a pumplike action of the cheeks, tongue, pharynx, and larynx (6), to fill their lungs beyond TLC by up to 2-3 liters (11,16,20,21). By employing this maneuver, they can increase oxygen stored in the lungs (and, therefore, their breath-hold duration) and provide additional intrapulmonary gas to reduce dangerous chest compression (11) that can result in hemoptysis and pulmonary edema (7) during dives that have recently exceeded 150 m in depth (www.aida-international.org).…”

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confidence: 99%

Transpulmonary pressures and lung mechanics with glossopharyngeal insufflation and exsufflation beyond normal lung volumes in competitive breath-hold divers

Loring

O’Donnell²,

Butler³

et al. 2007

Journal of Applied Physiology

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Throughout life, most mammals breathe between maximal and minimal lung volumes determined by respiratory mechanics and muscle strength. In contrast, competitive breath-hold divers exceed these limits when they employ glossopharyngeal insufflation (GI) before a dive to increase lung gas volume (providing additional oxygen and intrapulmonary gas to prevent dangerous chest compression at depths recently greater than 100 m) and glossopharyngeal exsufflation (GE) during descent to draw air from compressed lungs into the pharynx for middle ear pressure equalization. To explore the mechanical effects of these maneuvers on the respiratory system, we measured lung volumes by helium dilution with spirometry and computed tomography and estimated transpulmonary pressures using an esophageal balloon after GI and GE in four competitive breath-hold divers. Maximal lung volume was increased after GI by 0.13-2.84 liters, resulting in volumes 1.5-7.9 SD above predicted values. The amount of gas in the lungs after GI increased by 0.59-4.16 liters, largely due to elevated intrapulmonary pressures of 52-109 cmH(2)O. The transpulmonary pressures increased after GI to values ranging from 43 to 80 cmH(2)O, 1.6-2.9 times the expected values at total lung capacity. After GE, lung volumes were reduced by 0.09-0.44 liters, and the corresponding transpulmonary pressures decreased to -15 to -31 cmH(2)O, suggesting closure of intrapulmonary airways. We conclude that the lungs of some healthy individuals are able to withstand repeated inflation to transpulmonary pressures far greater than those to which they would normally be exposed.

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confidence: 99%

Transpulmonary pressures and lung mechanics with glossopharyngeal insufflation and exsufflation beyond normal lung volumes in competitive breath-hold divers

Loring

O’Donnell²,

Butler³

et al. 2007

Journal of Applied Physiology

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“…A reduced hypercapnic and unchanged hypoxic ventilatory response in breath-hold divers is not surprising when considering that most of the duration of a breath-hold dive to depth is characterized by hypercapnic hyperoxia, as changes in ambient pressure are transmitted to the alveolar gases (Linér et al 1993). With the decrease in ambient pressure during ascent, the lowest oxygen levels are reached during the last phase of the ascent and at the surface (Stanek et al 1993), whereas hypercapnia is maintained throughout most of the dive (Linér et al 1993), at least if predive hyperventilation is avoided (Muth et al 2003). Thus, the diver has to resist the urge to breathe elicited mainly by the hypercapnic stimulation of chemoreceptors.…”

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confidence: 99%

Repeated apneas do not affect the hypercapnic ventilatory response in the short term

Andersson

Schagatay

2008

Eur J Appl Physiol

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Long-term training of breath-hold diving reduces the hypercapnic ventilatory response (HCVR), an index of the CO(2) sensitivity. The aim of the present study was to elucidate whether also short-term apnea training (repeating apneas with short intervals) reduces the HCVR, thereby being one contributing factor explaining the progressively increasing breath-holding time (BHT) with repetition of apneas. Fourteen healthy volunteers performed a series of five maximal-duration apneas with face immersion and two measurements of the HCVR, using the Read rebreathing method. The BHT increased by 43% during the series of apneas (P < 0.001). However, the slope of the HCVR test was not affected by the series of apneas, being 2.52 (SD 1.27) and 2.24 (SD 1.14) l min(-1) mmHg(-1) in the control test and in the test performed within 2 min after the last apnea of the series, respectively (NS). Thus, a change in the HCVR cannot explain the observed short-term training effect on BHT.

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“…Carbon dioxide often remains in the physiological range, probably due to extensive hyperventilation before the apnoea attempt [109][110][111]. Furthermore, as the diver goes deeper the increased surrounding hydrostatic pressure causes compression of the chest wall and lung squeeze with atelectasis formation, alveolar capillary membrane rupture, fluid filtration and bleeding into the alveolar space [112,113].…”

Section: Breath-hold Divingmentioning

confidence: 99%

Lung injury related to extreme environments

Adir

Bové

2014

Eur Respir Rev

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@ERSpublications Lung injury is a well understood and preventable consequence of water immersion while swimming and diving http://ow.ly/AOdvgAs extreme sports become more popular, related respiratory injury may compromise the athlete's performance and result in morbidity and even mortality. In this article we will discuss different lung injuries in relation to performing different activities in an extreme environment. Hydrostatic lung injuriesThe evolution of fish to amphibians, reptiles to endothermic birds and mammals has been accompanied by a progressively thinner pulmonary blood gas barrier, to accommodate the constraint of increased oxygen uptake and carbon dioxide output [1]. Accordingly, pulmonary circulation has evolved as a separate high flow-low pressure system. In humans, mean pulmonary artery pressures (PAP) are 8-20 mmHg, pulmonary wedge pressures are 5-14 mmHg and pulmonary capillary pressures are 8-12 mmHg [2]. A low-pressure regimen preserves the integrity of an alveolar capillary membrane only 0.3 mm thick. However, this structure is vulnerable to increased pressures during strenuous exercise or environmental hypoxic exposure as a cause of stress failure of the pulmonary capillaries and accumulation of extravascular lung water [3]. Reports of lung injury related to extremes of exercise and variations in ambient pressure and altitude confirm this vulnerability. The resulting lung injury takes the form of noncardiogenic pulmonary oedema.The occurrence of noncardiogenic pulmonary oedema and pulmonary haemorrhage has been described in relation to a variety of disorders related to auto-and exogenous immunological reactions, infections and certain inhalants. However, numerous reports of lung injury manifesting as pulmonary oedema with associated haemorrhage have been described more recently in relation to immersion underwater, swimming, extreme exercise and exposure to altitude. In addition, pulmonary oedema resulting from negative intra-alveolar pressure has been described in the anaesthesia literature and may play a role in exercise-and immersion-induced pulmonary oedema. Haemodynamically induced pulmonary oedemaA single mechanism responsible for production of noncardiogenic pulmonary oedema related to immersion, altitude and exercise has not been identified. However, a combination of haemodynamically related factors, alterations in capillary integrity, increased blood volume and increased cardiac output may all contribute to the syndrome. WEST et al.[4] described exercise-induced pulmonary haemorrhage in race For editorial comments see page 401.

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Arterial Blood Gases During Diving in Elite Apnea Divers

Cited by 47 publications

References 14 publications

Transpulmonary pressures and lung mechanics with glossopharyngeal insufflation and exsufflation beyond normal lung volumes in competitive breath-hold divers

Transpulmonary pressures and lung mechanics with glossopharyngeal insufflation and exsufflation beyond normal lung volumes in competitive breath-hold divers

Repeated apneas do not affect the hypercapnic ventilatory response in the short term

Lung injury related to extreme environments

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