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Yu E, Valdivia-Valdivia JM, Silva F, Lindholm P. Breath-Hold Diving Injuries - A Primer for Medical Providers. Curr Sports Med Rep 2024; 23:199-206. [PMID: 38709946 DOI: 10.1249/jsr.0000000000001168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
ABSTRACT Breath-hold divers, also known as freedivers, are at risk of specific injuries that are unique from those of surface swimmers and compressed air divers. Using peer-reviewed scientific research and expert opinion, we created a guide for medical providers managing breath-hold diving injuries in the field. Hypoxia induced by prolonged apnea and increased oxygen uptake can result in an impaired mental state that can manifest as involuntary movements or full loss of consciousness. Negative pressure barotrauma secondary to airspace collapse can lead to edema and/or hemorrhage. Positive pressure barotrauma secondary to overexpansion of airspaces can result in gas embolism or air entry into tissues and organs. Inert gas loading into tissues from prolonged deep dives or repetitive shallow dives with short surface intervals can lead to decompression sickness. Inert gas narcosis at depth is commonly described as an altered state similar to that experienced by compressed air divers. Asymptomatic cardiac arrhythmias are common during apnea, normally reversing shortly after normal ventilation resumes. The methods of glossopharyngeal breathing (insufflation and exsufflation) can add to the risk of pulmonary overinflation barotrauma or loss of consciousness from decreased cardiac preload. This guide also includes information for medical providers who are tasked with providing medical support at an organized breath-hold diving event with a list of suggested equipment to facilitate diagnosis and treatment outside of the hospital setting.
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Affiliation(s)
- Elaine Yu
- University of California San Diego, Department of Emergency Medicine; San Diego, CA
| | | | - Fernando Silva
- Kaiser Permanente Vacaville Medical Center, Department of Emergency Medicine; Vacaville, CA
| | - Peter Lindholm
- University of California San Diego, Department of Emergency Medicine; San Diego, CA
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2
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Abstract
Pulmonary physiology is significantly altered during underwater exposure, as immersion of the body and increased ambient pressure elicit profound effects on both the cardiovascular and respiratory systems. Thoracic blood pooling, increased breathing gas pressures, and variations in gas volumes alongside ambient pressure changes put the heart and lungs under stress. Normal physiologic function and fitness of the cardiovascular and respiratory systems are prerequisites to safely cope with the challenges of the underwater environment when freediving, or diving with underwater breathing apparatus. Few physicians are trained to understand the physiology and medicine of diving and how to recognize or manage diving injuries. This article provides an overview of the physiologic challenges to the respiratory system during diving, with or without breathing apparatus, and outlines possible health risks and hazards unique to the underwater environment. The underlying pathologic mechanisms of dive-related injuries are reviewed, with an emphasis on pulmonary physiology and pathophysiology.
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Affiliation(s)
- Kay Tetzlaff
- Department of Sports Medicine, University Hospital of Tuebingen, Tuebingen, Germany
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Baranova T, Podyacheva E, Zemlyanukhina T, Berlov D, Danilova M, Glotov O, Glotov A. Vascular Reactions of the Diving Reflex in Men and Women Carrying Different ADRA1A Genotypes. Int J Mol Sci 2022; 23:ijms23169433. [PMID: 36012699 PMCID: PMC9409260 DOI: 10.3390/ijms23169433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
The diving reflex is an oxygen-saving mechanism which is accompanied by apnea, reflex bradycardia development, peripheral vasoconstriction, spleen erythrocyte release, and selective redistribution of blood flow to the organs most vulnerable to lack of oxygen, such as the brain, heart, and lungs. However, this is a poorly studied form of hypoxia, with a knowledge gap on physiological and biochemical adaptation mechanisms. The reflective sympathetic constriction of the resistive vessels is realized via ADRA1A. It has been shown that ADRA1A SNP (p.Arg347Cys; rs1048101) is associated with changes in tonus in vessel walls. Moreover, the Cys347 allele has been shown to regulate systolic blood pressure. The aim of this work was to evaluate whether the ADRA1A polymorphism affected the pulmonary vascular reactions in men and women in response to the diving reflex. Men (n = 52) and women (n = 50) untrained in diving aged 18 to 25 were recruited into the study. The vascular reactions and blood flow were examined by integrated rheography and rheography of the pulmonary artery. Peripheral blood circulation was registered by plethysmography. The ADRA1A gene polymorphism (p.Arg347Cys; rs1048101) was determined by PCR-RFLP. In both men and women, reflective pulmonary vasodilation did occur in response to the diving reflex, but in women this vasodilation was more pronounced and was accompanied by a higher filling of the lungs with blood.. Additionally, ADRA1A SNP (p.Arg347Cys; rs1048101) is associated with sex. Interestingly, women with the Arg347 allele demonstrated the highest vasodilation of the lung vessels. Therefore, our data may help to indicate women with the most prominent adaptive reactions to the diving reflex. Our data also indicate that women and men with the Cys allele of the ADRA1A gene polymorphism have the highest risk of developing lung hypertension in response to the diving reflex. The diving reflex is an oxygen-saving mechanism which is accompanied by apnea, reflex bradycardia development, peripheral vasoconstriction, spleen erythrocyte release, and selective redistribution of blood flow to the organs most vulnerable to lack of oxygen, such as the brain, heart, and lungs. However, this is a poorly studied form of hypoxia, with a knowledge gap on physiological and biochemical adaptation mechanisms.
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Affiliation(s)
- Tatyana Baranova
- Faculty of Biology, Saint Petersburg State University, 199034 Saint-Petersburg, Russia
- Correspondence: ; Tel.: +7-921-331-6581
| | - Ekaterina Podyacheva
- Faculty of Biology, Saint Petersburg State University, 199034 Saint-Petersburg, Russia
| | - Tatyana Zemlyanukhina
- Faculty of Biology, Saint Petersburg State University, 199034 Saint-Petersburg, Russia
| | - Dmitrii Berlov
- Faculty of Biology, Herzen State Pedagogical University of Russia, 191186 Saint-Petersburg, Russia
| | - Maria Danilova
- Department of Genomic Medicine, D.O. Ott’s Institute of Obstetrics, Gynecology and Reproductology, 199034 Saint-Petersburg, Russia
| | - Oleg Glotov
- Department of Genomic Medicine, D.O. Ott’s Institute of Obstetrics, Gynecology and Reproductology, 199034 Saint-Petersburg, Russia
- Department of Experimental Medical Virology, Molecular Genetics and Biobanking of Pediatric Research and Clinical Center for Infectious Diseases, 197022 Saint-Petersburg, Russia
| | - Andrey Glotov
- Department of Genomic Medicine, D.O. Ott’s Institute of Obstetrics, Gynecology and Reproductology, 199034 Saint-Petersburg, Russia
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The effect of breathing technique on sticking region during maximal bench press. Biol Sport 2021; 38:445-450. [PMID: 34475625 PMCID: PMC8329978 DOI: 10.5114/biolsport.2021.100362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/21/2020] [Accepted: 09/25/2020] [Indexed: 11/23/2022] Open
Abstract
The intrathoracic pressure and breathing strategy on bench press (BP) performance is highly discussed in strength competition practice. Therefore, the purpose of this study was to analyze whether different breathing techniques can influence the time and track characteristics of the sticking region (SR) during the 1RM BP exercise. 24 healthy, male adults (age 23 ± 2.4 yrs., body mass 85 ± 9.2 kg, height 181 ± 5.4 cm) performed a 1 repetition BP using the breathing technique of Valsalva maneuver (VM), hold breath, lung packing (PAC), and reverse breathing (REVB), while maximum lifted load and concentric phase kinematics were recorded. The results of ANOVA showed that the REVB breathing decreased absolute (p < 0.04) and relative lifted load (p < 0.01). The VM showed lower (p = 0.01) concentric time of the lift than the other breathing techniques. The VM and PAC showed lower SR time than other breathing techniques, where PAC showed a lower SR time than VM (p = 0.02). The PAC techniques resulted in shorter SR and pre-SR track than other breathing techniques and the REVB showed longer SR track than the other considered breathing techniques (p = 0.04). Thus, PAC or VM should be used for 1RM BP lifting according to preferences, experiences and lifting comfort of an athlete. The hold breath technique does not seem to excessively decrease the lifting load, but this method will increase the lifting time and the time spend in the sticking region, therefore its use does not provide any lifting benefit. The authors suggest that the REVB should not be used during 1 RM lifts.
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Usmani OS, Dhand R, Lavorini F, Price D. Why We Should Target Small Airways Disease in Our Management of Chronic Obstructive Pulmonary Disease. Mayo Clin Proc 2021; 96:2448-2463. [PMID: 34183115 DOI: 10.1016/j.mayocp.2021.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/12/2021] [Accepted: 03/16/2021] [Indexed: 12/23/2022]
Abstract
For more than 50 years, small airways disease has been considered a key feature of chronic obstructive pulmonary disease (COPD) and a major cause of airway obstruction. Both preventable and treatable, small airways disease has important clinical consequences if left unchecked. Small airways disease is associated with poor spirometry results, increased lung hyperinflation, and poor health status, making the small airways an important treatment target in COPD. The early detection of small airways disease remains the key barrier; if detected early, treatments designed to target small airways may help reduce symptoms and allow patients to maintain their activities. Studies are needed to evaluate the possible role of new drugs and novel drug formulations, inhalers, and inhalation devices for treating small airways disease. These developments will help to improve our management of small airways disease in patients with COPD.
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Affiliation(s)
- Omar S Usmani
- National Heart and Lung Institute, Imperial College London, and Royal Brompton Hospital, Airways Disease Section, London, UK.
| | - Rajiv Dhand
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville
| | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - David Price
- Observational and Pragmatic Research Institute, Singapore; Optimum Patient Care, Cambridge, UK; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Tetzlaff K, Lemaitre F, Burgstahler C, Luetkens JA, Eichhorn L. Going to Extremes of Lung Physiology-Deep Breath-Hold Diving. Front Physiol 2021; 12:710429. [PMID: 34305657 PMCID: PMC8299524 DOI: 10.3389/fphys.2021.710429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 01/03/2023] Open
Abstract
Breath-hold diving involves environmental challenges, such as water immersion, hydrostatic pressure, and asphyxia, that put the respiratory system under stress. While training and inherent individual factors may increase tolerance to these challenges, the limits of human respiratory physiology will be reached quickly during deep breath-hold dives. Nonetheless, world records in deep breath-hold diving of more than 214 m of seawater have considerably exceeded predictions from human physiology. Investigations of elite breath-hold divers and their achievements revised our understanding of possible physiological adaptations in humans and revealed techniques such as glossopharyngeal breathing as being essential to achieve extremes in breath-hold diving performance. These techniques allow elite athletes to increase total lung capacity and minimize residual volume, thereby reducing thoracic squeeze. However, the inability of human lungs to collapse early during descent enables respiratory gas exchange to continue at greater depths, forcing nitrogen (N2) out of the alveolar space to dissolve in body tissues. This will increase risk of N2 narcosis and decompression stress. Clinical cases of stroke-like syndromes after single deep breath-hold dives point to possible mechanisms of decompression stress, caused by N2 entering the vasculature upon ascent from these deep dives. Mechanisms of neurological injury and inert gas narcosis during deep breath-hold dives are still incompletely understood. This review addresses possible hypotheses and elucidates factors that may contribute to pathophysiology of deep freediving accidents. Awareness of the unique challenges to pulmonary physiology at depth is paramount to assess medical risks of deep breath-hold diving.
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Affiliation(s)
- Kay Tetzlaff
- Department of Sports Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Frederic Lemaitre
- Faculte des Sciences du Sport et de l'Education Physique, Universite de Rouen, Rouen, France
| | - Christof Burgstahler
- Department of Sports Medicine, University Hospital of Tübingen, Tübingen, Germany
| | | | - Lars Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Physiology, pathophysiology and (mal)adaptations to chronic apnoeic training: a state-of-the-art review. Eur J Appl Physiol 2021; 121:1543-1566. [PMID: 33791844 PMCID: PMC8144079 DOI: 10.1007/s00421-021-04664-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023]
Abstract
Breath-hold diving is an activity that humans have engaged in since antiquity to forage for resources, provide sustenance and to support military campaigns. In modern times, breath-hold diving continues to gain popularity and recognition as both a competitive and recreational sport. The continued progression of world records is somewhat remarkable, particularly given the extreme hypoxaemic and hypercapnic conditions, and hydrostatic pressures these athletes endure. However, there is abundant literature to suggest a large inter-individual variation in the apnoeic capabilities that is thus far not fully understood. In this review, we explore developments in apnoea physiology and delineate the traits and mechanisms that potentially underpin this variation. In addition, we sought to highlight the physiological (mal)adaptations associated with consistent breath-hold training. Breath-hold divers (BHDs) are evidenced to exhibit a more pronounced diving-response than non-divers, while elite BHDs (EBHDs) also display beneficial adaptations in both blood and skeletal muscle. Importantly, these physiological characteristics are documented to be primarily influenced by training-induced stimuli. BHDs are exposed to unique physiological and environmental stressors, and as such possess an ability to withstand acute cerebrovascular and neuronal strains. Whether these characteristics are also a result of training-induced adaptations or genetic predisposition is less certain. Although the long-term effects of regular breath-hold diving activity are yet to be holistically established, preliminary evidence has posed considerations for cognitive, neurological, renal and bone health in BHDs. These areas should be explored further in longitudinal studies to more confidently ascertain the long-term health implications of extreme breath-holding activity.
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Schipke JD, Lemaitre F, Cleveland S, Tetzlaff K. Effects of Breath-Hold Deep Diving on the Pulmonary System. Respiration 2019; 97:476-483. [PMID: 30783070 DOI: 10.1159/000495757] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/24/2018] [Indexed: 11/19/2022] Open
Abstract
This short review focuses on pulmonary injury in breath-hold (BH) divers. When practicing their extreme leisure sport, they are exposed to increased pressure on pulmonary gas volumes, hypoxia, and increased partial gas pressures. Increasing ambient pressures do present a serious problem to BH deep divers, because the semi-rigid thorax prevents the deformation required by the Boyle-Mariotte law. As a result, a negative-pressure barotrauma (lung squeeze) with acute hemoptysis is not uncommon. Respiratory maneuvers such as glossopharyngeal insufflation (GI) and glossopharyngeal exsufflation (GE) are practiced to prevent lung squeeze and to permit equalizing the paranasal sinuses and the middle ear. GI not only impairs venous return, thereby provoking hypotension and even fainting, but also produces intrathoracic pressures likely to induce pulmonary barotrauma that is speculated to induce long-term injury. GE, in turn, further increases the already negative intrapulmonary pressure, thereby favoring alveolar collapse (atelectasis). Finally, hypoxia seemingly not only induces brain injury but initiates the opening of intrapulmonary shunts. These pathways are large enough to permit transpulmonary passage of venous N2 bubbles, making stroke-like phenomena in deep BH divers possible.
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Affiliation(s)
- Jochen D Schipke
- Research Group Experimental Surgery, University Hospital Düsseldorf, Düsseldorf, Germany,
| | - Frederic Lemaitre
- UFR Sciences du Sport et de l'Éducation Physique, Université de Rouen, Mont-Saint-Aignan, France
| | - Sinclair Cleveland
- Institute of Neuro- and Sensory Physiology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kay Tetzlaff
- Department of Sports Medicine, Medical Clinic, Eberhard Karls University of Tübingen, Tübingen, Germany
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Schipke JD, Eichhorn L, Behm P, Cleveland S, Kelm M, Boenner F. Glossopharyngeal insufflation and kissing papillary muscles. Scand J Med Sci Sports 2018; 29:299-304. [PMID: 30376212 DOI: 10.1111/sms.13329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jochen D Schipke
- c/o Forschungsgruppe Experimentelle Chirurgie, Universitäts-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Lars Eichhorn
- Clinic and Policlinic for Anaesthesiology and Operative Intensive Care Medicine, University of Bonn, Bonn, Germany
| | - Patrick Behm
- Clinic for Cardiology, Pneumology & Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Sinclair Cleveland
- Institute of Neuro- and Sensory Physiology, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Clinic for Cardiology, Pneumology & Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Florian Boenner
- Clinic for Cardiology, Pneumology & Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
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Schipke JD, Kelm M, Siegmund K, Muth T, Sievers B, Steiner S. "Lung packing" in breath hold-diving: An impressive case of pulmo-cardiac interaction. Respir Med Case Rep 2016; 16:120-1. [PMID: 26744675 PMCID: PMC4681964 DOI: 10.1016/j.rmcr.2015.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 09/13/2015] [Accepted: 09/14/2015] [Indexed: 12/02/2022] Open
Abstract
There is a complex interaction between the heart and the lungs. We report on a healthy female who performs breath hold diving at a high, international level. In order to optimize pressure equalization during diving and to increase oxygen available, apneists employed a special breathing maneuver, so called “lung packing”. Based on cardiac MRI we could demonstrate impressive effects of this maneuver on left ventricular geometry and hemodynamics. Beyond the fact, that our findings support the concept of pulmonary –cardiac interrelationship, it should be emphasized, that the reported, extreme breathing maneuver could have detrimental consequences due to reduction of stroke volume and cardiac output.
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Affiliation(s)
- Jochen D Schipke
- Research Group Experimental Surgery, University Hospital Düsseldorf, Moorenstraße 5, D-40522 Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Moorensraße 5, D-40225 Düsseldorf, Germany
| | - Klaus Siegmund
- Institute of Occupational Medicine and Social Medicine, Heinrich Heine University Düsseldorf, Universitätsstrasse 1, D-40225 Düsseldorf, Germany
| | - Thomas Muth
- Institute of Occupational Medicine and Social Medicine, Heinrich Heine University Düsseldorf, Universitätsstrasse 1, D-40225 Düsseldorf, Germany
| | - Burkhard Sievers
- Department of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Moorensraße 5, D-40225 Düsseldorf, Germany
| | - Stephan Steiner
- Department of Cardiology, Pneumology and Int. Care Medicine, St. Vincenz Hospital Limburg, Auf dem Schafsberg, D-65549 Limburg, Germany
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Boussuges A, Gavarry O, Bessereau J, Coulange M, Bourc'his M, Rossi P. Glossopharyngeal insufflation and breath-hold diving: the more, the worse? Wilderness Environ Med 2014; 25:466-71. [PMID: 25443752 DOI: 10.1016/j.wem.2014.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The glossopharyngeal insufflation maneuver (lung packing) is largely performed by competitive breath-hold divers to improve their performance, despite observational evidence of fainting and loss of consciousness in the first seconds of apnea. METHODS We describe here the time course of hemodynamic changes, induced by breath-holding with and without lung packing, in 2 world-class apnea competitors. RESULTS When compared with apnea performed after a deep breath (100% vital capacity), lung packing leads to a decrease in cardiac output, blood pressure, and cerebral blood flow during the first seconds after the beginning of apnea. The major hemodynamic disorders were observed in diver 1, who exhibited the greater increase in pulmonary volume after lung packing (+22% for diver 1 vs +10% for diver 2). After the initial drop in both cardiac output and blood pressure, the time course of hemodynamic alterations became quite similar between the two apneas. CONCLUSIONS Some recommendations, such as limiting the number of maneuvers and performing lung packing in the supine position, should be expressed to avoid injuries secondary to the use of glossopharyngeal insufflation.
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Affiliation(s)
- Alain Boussuges
- UMR-MD2, French Armed Biomedical Research Institute, IRBA, Brétigny sur Orge, and Aix-Marseille University, Marseille, France (Drs Boussuges, Bessereau, Coulange, and Rossi).
| | - Olivier Gavarry
- Laboratoire HandiBio-EA 4322, Université du Sud Toulon Var, La Garde, France (Dr Gavarry)
| | - Jacques Bessereau
- UMR-MD2, French Armed Biomedical Research Institute, IRBA, Brétigny sur Orge, and Aix-Marseille University, Marseille, France (Drs Boussuges, Bessereau, Coulange, and Rossi); Pole RUSH, Assistance Publique des Hopitaux de Marseille, Marseille, France (Drs Bessereau and Coulange)
| | - Mathieu Coulange
- UMR-MD2, French Armed Biomedical Research Institute, IRBA, Brétigny sur Orge, and Aix-Marseille University, Marseille, France (Drs Boussuges, Bessereau, Coulange, and Rossi); Pole RUSH, Assistance Publique des Hopitaux de Marseille, Marseille, France (Drs Bessereau and Coulange)
| | | | - Pascal Rossi
- UMR-MD2, French Armed Biomedical Research Institute, IRBA, Brétigny sur Orge, and Aix-Marseille University, Marseille, France (Drs Boussuges, Bessereau, Coulange, and Rossi); Internal Medicine Department, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France (Dr Rossi)
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Kjeld T, Jattu T, Nielsen HB, Goetze JP, Secher NH, Olsen NV. Release of erythropoietin and neuron-specific enolase after breath holding in competing free divers. Scand J Med Sci Sports 2014; 25:e253-7. [DOI: 10.1111/sms.12309] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- T. Kjeld
- Department of Anesthesia (The Copenhagen Muscle Research Center); Rigshospitalet; Copenhagen Denmark
- Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | - T. Jattu
- Department of Anesthesia (The Copenhagen Muscle Research Center); Rigshospitalet; Copenhagen Denmark
| | - H. B. Nielsen
- Department of Anesthesia (The Copenhagen Muscle Research Center); Rigshospitalet; Copenhagen Denmark
| | - J. P. Goetze
- Department of Clinical Biochemistry; Rigshospitalet; Copenhagen Denmark
| | - N. H. Secher
- Department of Anesthesia (The Copenhagen Muscle Research Center); Rigshospitalet; Copenhagen Denmark
| | - N. V. Olsen
- Department of Neuroanesthesia; Rigshospitalet; Copenhagen Denmark
- Department of Neuroscience and Pharmacology; University of Copenhagen; Copenhagen Denmark
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14
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DeVanna JC, Kornegay JN, Bogan DJ, Bogan JR, Dow JL, Hawkins EC. Respiratory dysfunction in unsedated dogs with golden retriever muscular dystrophy. Neuromuscul Disord 2013; 24:63-73. [PMID: 24295812 DOI: 10.1016/j.nmd.2013.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 12/30/2022]
Abstract
Golden retriever muscular dystrophy (GRMD) is a well-established model of Duchenne muscular dystrophy. The value of this model would be greatly enhanced with practical tools to monitor progression of respiratory dysfunction during treatment trials. Arterial blood gas analysis, tidal breathing spirometry, and respiratory inductance plethysmography (RIP) were performed to determine if quantifiable abnormalities could be identified in unsedated, untrained, GRMD dogs. Results from 11 dogs with a mild phenotype of GRMD and 11 age-matched carriers were compared. Arterial blood gas analysis was successfully performed in all dogs, spirometry in 21 of 22 (95%) dogs, and RIP in 18 of 20 (90%) dogs. Partial pressure of carbon dioxide and bicarbonate concentration were higher in GRMD dogs. Tidal breathing peak expiratory flows were markedly higher in GRMD dogs. Abnormal abdominal motion was present in 7 of 10 (70%) GRMD dogs. Each technique provided objective, quantifiable measures that will be useful for monitoring respiratory function in GRMD dogs during clinical trials while avoiding the influence of sedation on results. Increased expiratory flows and the pattern of abdominal breathing are novel findings, not reported in people with Duchenne muscular dystrophy, and might be a consequence of hyperinflation.
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Affiliation(s)
- Justin C DeVanna
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, United States
| | - Joe N Kornegay
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States; Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States; The Gene Therapy Center, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Daniel J Bogan
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States; Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States; The Gene Therapy Center, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Janet R Bogan
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States; Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States; The Gene Therapy Center, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Jennifer L Dow
- Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States; Department of Neurology, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States; The Gene Therapy Center, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Eleanor C Hawkins
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, United States.
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Batinic T, Utz W, Breskovic T, Jordan J, Schulz-Menger J, Jankovic S, Dujic Z, Tank J. Cardiac magnetic resonance imaging during pulmonary hyperinflation in apnea divers. Med Sci Sports Exerc 2012; 43:2095-101. [PMID: 21552160 DOI: 10.1249/mss.0b013e31821ff294] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Apnea divers hyperinflate the lung by taking a deep breath followed by glossopharyngeal insufflation. The maneuver can lead to symptomatic arterial hypotension. We tested the hypotheses that glossopharyngeal insufflation interferes with cardiac function further reducing cardiac output (CO) using cardiac magnetic resonance imaging (MRI) to fully sample both cardiac chambers. METHODS Eleven dive athletes (10 men, 1 woman; age = 26 ± 5 yr, body mass index = 23.5 ± 1.7 kg·m(-2)) underwent cardiac MRI during breath holding at functional residual capacity (baseline), at total lung capacity (apnea), and with submaximal glossopharyngeal insufflation. Lung volumes were estimated from anatomic images. Short-axis cine MR images were acquired to study biventricular function. Dynamic changes were followed by long-axis cine MRI. RESULTS Left and right ventricular end-diastolic volumes (LVEDV, RVEDV) decreased during apnea with and without glossopharyngeal insufflation (baseline: LVEDV = 198 ± 19 mL, RVEDV = 225 ± 30 mL; apnea: LVEDV = 125 ± 38 mL, RVEDV = 148 ± 37 mL, P < 0.001; glossopharyngeal insufflation: LVEDV = 108 ± 26 mL, RVEDV = 136 ± 29 mL, P < 0.001 vs baseline). CO decreased during apnea (left = -29 ± 4 %, right = -29 ± 4 %) decreasing further with glossopharyngeal insufflation (left = -38% ± 4%, right = -39% ± 4%, P < 0.05). HR increased 16 ± 4 bpm with apnea and 17 ± 5 bpm with glossopharyngeal insufflation (P < 0.01). Ejection fraction moderately decreased (apnea: left = -5% ± 2%, right = -7% ± 2%, glossopharyngeal insufflation: left = -6% ± 2%, right = -10% ± 2%, P < 0.01). With continued apnea with and without glossopharyngeal insufflation, LVEDV and CO increased over time by a similar but small amount (P < 0.01). CONCLUSIONS The major finding of our study was that submaximal glossopharyngeal insufflation decreased CO further albeit by a small amount compared to maximal inspiratory apnea. The response was not associated with severe biventricular dysfunction.
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Affiliation(s)
- Tonci Batinic
- Department of Radiology, University Hospital Split, Croatia
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Walterspacher S, Scholz T, Tetzlaff K, Sorichter S. Breath-hold diving: respiratory function on the longer term. Med Sci Sports Exerc 2011; 43:1214-9. [PMID: 21200343 DOI: 10.1249/mss.0b013e31820a4e0c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Extensive breath-hold (BH) diving imposes high pulmonary stress by performing voluntary lung hyperinflation maneuvers (glossopharyngeal insufflation, GI), hyperinflating the lung up to 50% of total lung capacity. Breath-hold durations of up to 10 min without oxygen support may also presume cerebral alterations of respiratory drive. Little is known about the long-term effects of GI onto the pulmonary parenchyma and respiratory adaptation processes in this popular extreme sport. METHODS Lung function assessments and subsequent measures of pulmonary static compliance were obtained for 5 min after GI in 12 elite competitive breath-hold divers (BHD) with a mean apnea diving performance of 6.6 yr. Three-year follow-up measurements were performed in 4 BHD. Respiratory drive was assessed in steady-state measurements for 6% and 9% CO2 in ambient air. RESULTS Short-term pulmonary stress effects for static compliance during GI (13.75 L·kPa) could be confirmed in these 12 divers without exhibiting permanent changes to the lungs' distensibility (7.41 L·kPa) or lung function parameters as confirmed by the follow-up measurements and for 4 BHD after 3 yr (P>0.05). Respiratory drive was significantly reduced in these BHD revealing a characteristic breathing pattern with a significant increase in VE and mouth occlusion pressure (P0.1) between free breathing and 6% CO2, as well as between 6% CO2 and 9% CO2 (all P<0.001). CONCLUSION BH diving with performance of GI does not permanently alter pulmonary distensibility or impair ventilatory flows and volumes. A blunted response to elevated CO2 concentrations could be demonstrated, which was supportive of the hypothesis that CO2 tolerance is a training effect due to BH diving rather than being an inherited phenomenon.
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EICHINGER MONIKA, WALTERSPACHER STEPHAN, SCHOLZ TOBIAS, TETZLAFF RALF, PUDERBACH MICHAEL, TETZLAFF KAY, KOPP-SCHNEIDER ANNETTE, LEY SEBASTIAN, CHOE KYUOK, KAUCZOR HANSULRICH, SORICHTER STEPHAN. Glossopharyngeal Insufflation and Pulmonary Hemodynamics in Elite Breath Hold Divers. Med Sci Sports Exerc 2010; 42:1688-95. [DOI: 10.1249/mss.0b013e3181d85dc3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lemaître F, Clua E, Andréani B, Castres I, Chollet D. Ventilatory function in breath-hold divers: effect of glossopharyngeal insufflation. Eur J Appl Physiol 2010; 108:741-7. [PMID: 20187279 DOI: 10.1007/s00421-009-1277-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study was conducted to determine whether ventilatory parameters would change in breath-hold divers (BHDs) after they performed the glossopharyngeal technique for lung insufflation. Fifteen elite BHDs, 16 non-expert BHDs and 15 control subjects participated in this cross-sectional study. Volumes and expiratory flow rates were measured twice, before and after the glossopharyngeal technique performed at rest. Before the technique, greater forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV(1)) and lower FEV(1)/FVC were noted in the elite and non-expert BHDs compared with controls. No difference was noted regarding the other pulmonary parameters. After the technique, increases were noted in FVC, FEV(1) and maximal voluntary ventilation in the elite BHDs (P < 0.001, respectively). The FEF(25-75%)/FVC ratios were lower in the BHDs both before and after the technique, indicating possible dysanapsis. The ventilatory parameters observed after the glossopharyngeal technique indicated (1) higher lung volumes in expert BHDs and (2) a correlation with BHD performance (maximal dynamic BH performance). This correlation became more significant after the technique, indicating a positive effect of glossopharyngeal insufflation on performance.
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Affiliation(s)
- Frederic Lemaître
- Centre d'Etudes des Transformations des Activités Physiques et Sportives, Faculté des Sciences du Sport et de l'Education Physique de Rouen, Université de Rouen, Boulevard Siegfried, Mont-Saint-Aignan, Rouen, 76130, France.
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Sun Y, Butler JP, Lindholm P, Walvick R, Loring SH, Gereige J, Ferrigno M, Albert MS. Marked pericardial inhomogeneity of specific ventilation at total lung capacity and beyond. Respir Physiol Neurobiol 2009; 169:44-9. [PMID: 19664729 PMCID: PMC2758696 DOI: 10.1016/j.resp.2009.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 07/10/2009] [Accepted: 07/29/2009] [Indexed: 11/18/2022]
Abstract
We measured regional ventilation at 1l above functional residual capacity (FRC+1L) and total lung capacity (TLC) in three normal subjects and four elite breath-hold divers, and above TLC after glossopharyngeal insufflation (TLC+GI) in the divers. Hyperpolarized (3)He MRI was used to map the local ventilation per unit volume over the entire lung. At TLC and above, there was markedly increased regional ventilation of the lungs in the pericardial region compared with the relatively uniform ventilation throughout the rest of the lung. The distribution of fractional ventilation regionally was relatively uniform at FRC+1L, with a small non-gravitational cephalocaudal gradient of specific ventilation in the supine posture. Our observations at high lung volumes are consistent with the effect of high pleural tension in the concave pericardial region, which promotes expansion of the subjacent lung, leading to a higher local effective compliance and a higher specific ventilation.
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Affiliation(s)
- Yanping Sun
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115: ;
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA 01655; ;
| | - James P. Butler
- Molecular and Integrative Physiological Science Program, Department of Environmental Health, Harvard School of Public Health, and Department of Medicine, Harvard Medical School, Boston, MA 02115;
| | - Peter Lindholm
- Department of Radiology, Karolinska Hospital and Department of Physiology and Pharmacology Karolinska Institutet, Stockholm, 17177, Sweden;
| | - Ronn Walvick
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA 01655; ;
| | - Stephen H. Loring
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215;
| | - Jessica Gereige
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115: ;
| | - Massimo Ferrigno
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115;
| | - Mitchell S. Albert
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115: ;
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA 01655; ;
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Lindholm P, Norris CM, Braver JM, Jacobson F, Ferrigno M. A fluoroscopic and laryngoscopic study of glossopharyngeal insufflation and exsufflation. Respir Physiol Neurobiol 2009; 167:189-94. [DOI: 10.1016/j.resp.2009.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 04/01/2009] [Accepted: 04/13/2009] [Indexed: 10/20/2022]
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