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Exogenous Nitric Oxide may reduce bubble formation in both wet and dry divers.
{|
| '''Clinical Bottom Line:''' 1. Dry diving produces fewer bubbles than wet diving.2. Nitroglycerine probably reduces bubble formation in both wet and dry dives.
|-
|}
'''Citation:'''Dujic Z, Palada I, Valic Z, Duplancic D, Obad A, Wisløff U, Brubakk A: Exogenous nitric oxide and bubble formation in divers. Med Sci Sports Exerc. 2006 Aug;38(8):1432-5.
'''Lead author's name and e-mail:''' Zeljko Dujic, [[mailto:zdujic@bsb.mefst.hr | zdujic@bsb.mefst.hr]]

'''Three-part Clinical Question:''' Among divers, would a short lasting NO-donor, nitroglycerine, reduce bubble formation after standard dives and decompression in man?
'''Search Terms:''' Decompression Illness, Nitric Oxide, Diving

'''The Study:'''Non-blinded randomised trial with intention-to-treat.
'''The Study Patients:''' 16 experienced divers. All fit and well.
'''Control groups''' (N =16; 16 analysed): 10 Wet divers, 30 msw, swimming for 500 m. Bottom time 30 min with 3 min safety stop at 3 msw. 6 Dry divers, 18 msw, bottom time 75 min with stop at 3 msw for 7 minutes.
'''Experimental groups''' (N =16; 16 analysed): As above preceded by 0.4 mg of nitroglycerine oral spray 30 min before diving.

'''The Evidence:'''
{|
| '''Measure''' |||| '''Control Group''' |||| '''Nitroglycerine Group''' || '''Difference''' || '''95% CI'''
|-
|^ || '''Mean''' || '''SD''' || '''Mean''' || '''SD''' ||^ ||^
|-
| '''Wet dive (bubbles/cm²) N ''' 10''' || 0.87 || 1.3 || 0.32 || 0.7 || 0.55 || -0.43 to 1.53
|-
| '''Dry dive (bubbles/cm²) N ''' 6''' || 0.12 || 0.23 || 0.03 || 0.03 || 0.09 || -0.12 to 0.30
|-
| |||| '''Wet divers N'''10''' |||| '''Dry divers N'''6''' ||||
|-
| '''Wet vs. dry dive (bubbles/cm²)''' || 0.87 || 1.3 || 0.12 || 0.23 || 0.75 || -0.42 to 1.92
|-
|}
'''Comments:'''
1. The allocation to wet versus dry diving was randomised, but all divers then did the control dive followed by the nitroglycerine dive. 
2. Our table reflects an independent t-test for the significance of the difference for the NO/no-NO comparisons. The authors used a paired t-test for these sequential dives and reported a P-value of 0.04 (wet dives) and 0.05 (dry dives). 
3. Results may not extrapolate to all divers - only divers with "considerable experience of air and oxygen diving" were eligible.
4. No side-effects measured.

'''Appraised by:''' Ing Han Gho and Mike Bennett, Prince of Wales Hospital, Sydney; Friday, 1 August 2008Email: [[mailto:m.bennett@unsw.edu.au | m.bennett@unsw.edu.au]]
'''Kill or Update By:''' December 2021

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