Chest
Volume 112, Issue 3, September 1997, Pages 654-659
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Clinical Investigations: Water Sports
Risk Factors for Pulmonary Barotrauma in Divers

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Study objectives

Pulmonary barotrauma (PBT) of ascent is a feared complication in compressed air diving. Although certain respiratory conditions are thought to increase the risk of suffering PBT and thus should preclude diving, in most cases of PBT, risk factors are described as not being present. The purpose of our study was to evaluate factors that possibly cause PBT.

Design

We analyzed 15 consecutive cases of PBT with respect to dive factors, clinical and radiologic features, and lung function. They were compared with 15 cases of decompression sickness without PBT, which appeared in the same period.

Results

Clinical features of PBT were arterial gas embolism (n= 13), mediastinal emphysema (n=1), and pneumothorax (n=1). CT of the chest (performed in 12 cases) revealed subpleural emphysematous blebs in 5 cases that were not detected in preinjury and postinjury chest radiographs. A comparison of predive lung function between groups showed significantly lower midexpiratory flow rates at 50% and 25% of vital capacity in PBT patients (p<0.05 and p<0.02, respectively).

Conclusions

These results indicate that divers with preexisting small lung cysts and/or end-expiratory flow limitation may be at risk of PBT.

Section snippets

Materials and Methods

We studied 15 PBT patients, who had been referred to our department consecutively, and compared them with 15 patients who suffered neurologic decompression sickness (DCS type 2). There were 11 male and 4 female divers in both groups. Seven patients in the PBT group were current smokers vs nine in the DCS group (Table 1). Among the PBT patients, there were three military divers, one police diver, one commercial diver, seven sports divers, two submarine escape tank trainees, and one hyperbaric

Results

PBT patients were younger than DCS patients (25.2 vs 27.9 years; p=0.07). No significant differences between groups were found with respect to body height (p=0.51) or weight (p = 0.54) (Table 1).

Among the patients who suffered PBT from diving, there were 13 cases of arterial gas embolism, 1 case of pneumothorax, and 1 case of mediastinal emphysema. In 3 of 13 cases, arterial gas embolism was accompanied by mediastinal emphysema and pneumothorax. All but one were first incidents; one female

Discussion

PBT in diving refers to tissue injury resulting from expanding gas during ascent which is not able to escape through the airways, due to Boyle's law, which states that there is an inverse relationship between the volume of a gas and the pressure applied.7 Breath-holding during rapid ascent and pulmonary diseases, particularly conditions that predispose to gas trapping, may contribute to the risk of PBT. Bullous diseases,13 asthma,14 and pleural adhesions15 have been described as possible causes

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