EXPERT’S OPINION   Free access

Minerva Anestesiologica 2019 October;85(10):1129-37

DOI: 10.23736/S0375-9393.19.13618-8

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Diving physiopathology: the end of certainties? Food for thought

Costantino BALESTRA ^{1, 2}, Peter GERMONPRÉ ^{1, 2, 3}, Monica ROCCO ⁴ ✉, Gianni BIANCOFIORE ⁵, Jacek KOT ⁶

¹ Laboratory of Environmental and Occupational (Integrative) Physiology, Haute Ecole Bruxelles-Brabant, Auderghem, Brussels, Belgium; ² Division of Research, Divers Alert Network Europe, Gharghur, Malta; ³ Center for Hyperbaric Oxygen Therapy, Military Hospital of Brussels, Brussels, Belgium; ⁴ Unit of Intensive Care, Department of Surgical and Medical Science and Translational Medicine, Sapienza University, Rome, Italy; ⁵ Unit of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy; ⁶ National Center of Hyperbaric Medicine in Gdynia, Medical University of Gdansk, Gdansk, Poland

Our understanding of decompression physiopathology has slowly improved during this last decade and some uncertainties have disappeared. A better understanding of anatomy and functional aspects of patent foramen ovale (PFO) have slowly resulted in a more liberal approach toward the medical fitness to dive for those bearing a PFO. Circulating vascular gas emboli (VGE) are considered the key actors in development of decompression sickness and can be considered as markers of decompression stress indicating induction of pathophysiological processes not necessarily leading to occurrence of disease symptoms. During the last decade, it has appeared possible to influence post-dive VGE by a so-called “preconditioning” as a pre-dive denitrogenation, exercise or some pharmacological agents. In the text we have deeply examined all the scientific evidence about this complicated but challenging theme. Finally, the role of the “normobaric oxygen paradox” has been clarified and it is not surprising that it could be involved in neuroprotection and cardioprotection. However, the best level of inspired oxygen and the exact time frame to achieve optimal effect is still not known. The aim of this paper was to reflect upon the most actual uncertainties and distil out of them a coherent, balanced advice towards the researchers involved in gas-bubbles-related pathologies.

KEY WORDS: Diving; Decompression sickness; Physiopathology