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Minerva Anestesiol. 2019 Jun 20. doi: 10.23736/S0375-9393.19.13618-8. [Epub ahead of print]

Diving physiopathology: the end of certainties? Food for thought.

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Haute Ecole Bruxelles-Brabant, Environmental & Occupational (Integrative) Physiology Laboratory, Brussels, Belgium.
Divers Alert Network Europe, Research Division, Ta' Xbiex, Malta.
Centre for Hyperbaric Oxygen Therapy, Military Hospital Brussels, Brussels, Belgium.
Intensive Care Unit, Department of Surgical and Medical Science and Translational Medicine, Sapienza University, Rome, Italy -
Anaesthesia and Intensive Care, University of Pisa, Pisa, Italy.
National Centre of Hyperbaric Medicine in Gdynia, Medical University of Gdansk, Gdynia, 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 is 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.

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