Department of Hyperbaric Medicine, Louisiana State University, New Orleans, Louisiana U.S.
Department of Emergency Medicine, University of Texas Medical Branch, Galveston, Texas U.S.
Undersea Hyperb Med. 2020 Fourth Quarter;47(4):531-537. doi: 10.22462/10.12.2020.1.
Pulmonary fluid shifts can occur while scuba diving. Such shifts, generally thought to be rare, may result in a life-threatening phenomenon known as immersion pulmonary edema (IPE). This study aims to better classify the normal physiology of diving using ultrasound (US) to determine if these fluid shifts occur routinely during commercial diving work at the NASA Neutral Buoyancy Laboratory (NBL).
Chest US was performed on commercial divers prospectively pre- and post-dive to evaluate the presence of B-lines in a total of 12 intercostal points on the anterior, posterior, and lateral chest wall. The number of B-lines at each anatomic site was recorded and scored by two independent reviewers. An increase in the number of B-lines post-dive was considered a positive result.
There were 67 exposures; 39 (58%) had an increase of one or more B-lines post dive; 64% of the female exposures and 57% of the male exposures were positive for B-lines post-dive, suggesting no difference across gender (Fisher's exact; p = 0.763). After the dive, all divers remained asymptomatic.
From our results, fluid shifts can be viewed as a normal, transient, and physiologic process in commercial divers. This correlation can be compared to the formation of low-grade venous gas emboli (VGE) from decompression that does not result in decompression sickness. Further study of US B-lines in symptomatic divers may define the utility of field US in the diagnosis and management of IPE, and help identify associated risk factors.
在水肺潜水时可能会发生肺部液体转移。这些转移通常被认为很少见，但可能导致一种危及生命的现象，即浸水性肺水肿（IPE）。本研究旨在使用超声（US）更好地对潜水的正常生理学进行分类，以确定这些液体转移是否在 NASA 中性浮力实验室（NBL）的商业潜水工作中经常发生。
对商业潜水员进行前瞻性潜水前和潜水后胸部 US 检查，以评估在前、后和侧胸壁的总共 12 个肋间点上是否存在 B 线。记录并由两位独立审阅者对每个解剖部位的 B 线数量进行评分。潜水后 B 线数量增加被认为是阳性结果。
有 67 次暴露；39 次（58%）潜水后 B 线增加一个或多个；64%的女性暴露和 57%的男性暴露潜水后 B 线阳性，表明性别之间无差异（Fisher 确切检验；p = 0.763）。潜水后，所有潜水员均无症状。
根据我们的结果，液体转移可被视为商业潜水员的正常、短暂和生理过程。这一关联可以与减压引起的低等级静脉气体栓塞（VGE）的形成进行比较，而减压病不会导致 VGE。对有症状潜水员的 US B 线进一步研究可能会确定现场 US 在 IPE 诊断和管理中的效用，并有助于确定相关的危险因素。
