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. 2024 Oct 22;25(21):11367.
doi: 10.3390/ijms252111367.

Decompression Illness After Technical Diving Session in Mediterranean Sea: Oxidative Stress, Inflammation, and HBO Therapy

Simona Mrakic-Sposta  1   2 , Andrea Brizzolari  3   4 , Alessandra Vezzoli  1   3 , Carmela Graci  2 , Attilio Cimmino  2 , Tommaso Antonio Giacon  3 , Cinzia Dellanoce  1   2 , Alessandra Barassi  4 , Giovanni Sesana  2 , Gerardo Bosco  3
Affiliations

Decompression Illness After Technical Diving Session in Mediterranean Sea: Oxidative Stress, Inflammation, and HBO Therapy

Simona Mrakic-Sposta et al. Int J Mol Sci. .

Abstract

SCUBA diving poses risks due to pressure changes during descent (compression) and ascent (decompression). Decompression sickness (DCS) occurs due to gas bubble formation as the pressure decreases, causing joint pain, numbness, dizziness, or even paralysis and death. Immediate treatment involves 100% oxygen to help eliminate inert gases and hyperbaric oxygen therapy (HBOT), which is essential to reduce gas emboli formation and inflammation, thus improving symptoms. We evaluated oxy-inflammation biomarkers in the saliva and urine of nine subjects pre- and post-technical dive on the Haven wreck (GE, Italy). A case of DCS occurred during the dive. The injured diver was treated immediately with O2 and transported to the hyperbaric center of "ASST Ospedale Ca Granda" in Milan. He was treated following the U.S. Navy Treatment Table 5 at 2.8 ATA and the day after with Table 15 at 2.4 ATA. Venous blood and urine samples were collected before and after each HBO treatment. Our study shows that dive increased oxy-inflammation biomarkers (ROS +126%; lipid peroxidation +23%; interleukins-6 +81%, -1β +19%, and TNFα +84%) and nitric oxide metabolites levels (+36%). HBOT after a DCS episode reduced oxidative stress, lowering the very high marker of lipid peroxidation (8-iso-PGF2α), and inhibited inflammatory interleukins. Overall, HBOT improved physiological responses in the diver affected by DCS.

Keywords: HBO therapy; SCUBA diving; arterial gas embolism; decompression sickness; inflammation; nitric oxide; oxidative stress.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Panel plots of the oxy-inflammation biomarkers in divers and the evolution of concentration in the DCS-affected subject. Histogram plot of (A) salivary ROS production rate, (B) urinary lipid peroxidation (8-isoPGF2α), and salivary (C) IL-6, (D) IL-1β, and (E) TNF-α levels in all divers pre- and post-immersion. The red dot indicates the subject of the DCS case. Statistically significant differences comparisons are displayed as follows: *, p < 0.05; and ***, p < 0.001. At the right panel, inside the red box, the time course of (A1,A2) ROS production rate, (B1,B2) lipid peroxidation, (C1,C2) IL-6, (D1,D2) IL-1β, and (E1,E2) TNF-α levels from T0 to T3 in saliva (T0: 30 min before the dive; T1: 30 min after surfacing and DCS symptom onset; T2: 3 h after DCS symptom onset; T3: 6 h after DCS symptom onset) and plasmatic values for the two HBOT sessions in the injured subject.
Figure 2
Figure 2
Panel plots of NO metabolites and renal status in divers and the evolution of concentration in the DCS-affected subject. Histogram plot of urinary (A) NO metabolites, (B) creatinine, and (C) neopterin concentration in all divers pre- and post-immersion. The red dot indicates the subject of the DCS case. Statistically significant differences comparisons are displayed as follows: ***, p < 0. 001. At the right panel, inside the red box, the time course of (A1,A2) NOx, (B1,B2) creatinine, and (C1,C2) neopterin from T0 to T3 (T0: 30 min before the dive; T1: 30 min after surfacing and DCS symptom onset; T2: 3 h after DCS symptom onset; T3: 6 h after DCS symptom onset), and in the two HBOT sessions in the injured subject.
Figure 3
Figure 3
In the histograms, the VAS scores for general wellness, tiredness, nausea, agitation, happiness, and pain are recorded (A) for SCUBA divers all together; (B) from T0 to T3 (T0: 30 min before the dive; T1: 30 min after surfacing and DCS symptom onset; for T2: 3 h after DCS symptom onset; T3: 6 h after DCS symptom onset) and after the last HBOT treatment (T2_post) in the injured subject.
Figure 4
Figure 4
To the left, above, is the table with the SCUBA decompression profile. The bottom is the experimental timeline and timing of HBOT treatment. In detail, saliva and urine samples were collected at the following points: T0: pre-dive; T1: post-dive and simultaneously DCS onset; T2: 3 h post-DCS symptom onset and pre-oxygen breathing; T3: 6 h post-DCS symptom onset and post-oxygen breathing. At the hospital, blood and urine samples were drawn immediately before and after HBOT, respectively, in the first session (T1_pre and T1_post) and second session (T2_post). Scale assessments (BORG and/or VAS) were also performed as indicated in the experimental timeline protocol.
Figure 5
Figure 5
Dive on the Haven oil tanker wreck.
See this image and copyright information in PMC

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