Pre-dive normobaric oxygen reduces bubble formation in scuba divers

Oxygen pre-breathing is routinely employed as a protective measure to reduce the incidence of altitude decompression sickness in aviators and astronauts, but the effectiveness of normobaric oxygen before hyperbaric exposure has not been well explored. The objective of this study was to evaluate the effect of 30-min normobaric oxygen (O(2)) breathing before diving upon bubble formation in recreational divers. Twenty-one subjects (13 men and 8 women, mean age (SD) 33 +/- 8 years) performed random repetitive open-sea dives (surface interval of 100 min) to 30 msw for 30 min with a 6-min stop at 3 msw under four experimental protocols: "air-air" (control), "O(2)-O(2)", "O(2)-air" and "air-O(2)" where "O(2)" corresponds to a dive with oxygen pre-breathing and "air" a dive without oxygen administration. Post-dive venous gas emboli were examined by means of a precordial Doppler ultrasound. The results showed decreased bubble scores in all dives where preoxygenation had taken place (p < 0.01). Oxygen pre-breathing before each dive ("O(2)-O(2)" condition) resulted in the highest reduction in bubble scores measured after the second dive compared to the control condition (-66%, p < 0.05). The "O(2)-air" and "air-O(2) "conditions produced fewer circulating bubbles after the second dive than "air-air" condition (-47.3% and -52.2%, respectively, p < 0.05) but less bubbles were detected in "air-O(2) "condition compared to "O(2)-air" (p < 0.05). Our findings provide evidence that normobaric oxygen pre-breathing decreases venous gas emboli formation with a prolonged protective effect over time. This procedure could therefore be beneficial for multi-day repetitive diving.