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Consecutive trimix diving is associated with high incidence of gas bubbles arterialization

SCUBA diving is often associated with generation of venous gas bubbles (VGB) that occur during ascent and are eliminated in lungs. Some conditions, such as patent foramen ovale (PFO), bear the risk for arterialization of VGB. However, these events are rather rare in air diving protocols that adhere to standardized diving tables. The aim of this study was to examine whether VGB arterialization can be found at rest following consecutive dives with trimix (mixture of oxygen, helium and nitrogen), which is increasingly being used among divers. Seven male divers performed three dives in consecutive days with diving depths ranging from 63–65 m. VGB were monitored by ultrasound for 90 minutes after surfacing and graded on a scale from 0–5. These profiles produced a significant number of VGB. Furthermore, the arterialization of VGB was detected in 5/7 divers (71%) and in 8/21 dives (38%), with only one subject having detected PFO. Additionally, mean pulmonary artery pressure was significantly increased after each dive. The arterialized bubbles did not evoke any symptoms (or decompression sickness) in any subject. These data indicate that even conservative trimix diving is associated with high incidence of gas bubbles arterialization which, although acutely asymptomatic, requires caution and investigation of potential long term consequences.