Difference between revisions of "Ribicic"
(Created page with " <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:" times="" new="" roman",serif"=""><span style="color:black">50% oxygen breathing...") |
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| − | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:18.0pt"><span style="font-family:"><span style="color:black">50% oxygen breathing during decompression, but not 99% oxygen breathing, was associated with significantly reduced flow-mediated dilatation in the brachial artery.</span></span></span>'''</span> |
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| − | <span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="font-family:"><span style="color:black">Clinical bottom line</span></span></span>'''</span> |
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| − | '''<span style="font-size:large;"><span style="line-height:normal"><span style="font-family: | + | '''<span style="font-size:large;"><span style="line-height:normal"><span style="font-family:">1. 99% oxygen decompression reduced the bubble numbers after provocation<br/> 2. 50% oxygen decompression reduced FMD compared to either of the other breathing gases.</span></span></span>''' |
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| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Citation/s:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">1.Ribicic IŠ, Valic M, Božic J, Obad A, Glavaš D, Glavicic I, Valic Z. Influence of oxygen enriched gases during decompression on bubble formation and endothelial function in self-contained underwater breathing apparatus diving: a randomized controlled study. Croatian medical journal. 2019 Jun;60(3):265.</span></span></span></span><br/> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Three-part Clinical Question:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">For rebreather divers, does altering the proportion of oxygen in the breathing gas result in any differences in venous bubbling or endothelial function?<br/> '''Search Terms:''' Rebreather; nitrrox; venous gas embolism</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">The Study:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Non-blinded randomised controlled trial with intention-to-treat.<br/> '''The Study Patients:''' Fit adult experienced divers with no significant comorbidities or history of decompression illness.<br/> '''Control group''' (N = 10; 10 analysed): Air dive to 45msw with V-planner calculated decompression stops on air for a total dive time of 65 minutes.<br/> '''Experimental group''' (N = 10; 10 analysed): Same bottom time and depth but V-planner calculated decompression stops with 50% oxygen (from 21 msw, total dive time 45 mins) and 99% oxygen (from 6 msw and total dive time 43 mons).</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">The Evidence:</span></span></span>'''</span> |
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{| class="Table" style="border:solid windowtext 1.0pt" | {| class="Table" style="border:solid windowtext 1.0pt" | ||
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| − | | rowspan="2" style="width:158.25pt; border:solid windowtext 1.0pt" width="214" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | rowspan="2" style="width:158.25pt; border:solid windowtext 1.0pt" width="214" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Measure</span></span>'''</span></p> |
| − | | colspan="2" style="width:66.25pt; border:solid windowtext 1.0pt" width="90" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | colspan="2" style="width:66.25pt; border:solid windowtext 1.0pt" width="90" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Air Group</span></span>'''</span></p> |
| − | | colspan="2" style="width:68.1pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | colspan="2" style="width:68.1pt; border:solid windowtext 1.0pt" width="93" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">50% oxygen Group</span></span>'''</span></p> |
| − | | rowspan="2" style="width:61.65pt; border:solid windowtext 1.0pt" width="84" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | rowspan="2" style="width:61.65pt; border:solid windowtext 1.0pt" width="84" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Difference</span></span>'''</span></p> |
| − | | rowspan="2" style="width:87.55pt; border:solid windowtext 1.0pt" width="120" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | rowspan="2" style="width:87.55pt; border:solid windowtext 1.0pt" width="120" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">95% CI</span></span>'''</span></p> |
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| − | | style="width:31.85pt; border:solid windowtext 1.0pt" width="44" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width:31.85pt; border:solid windowtext 1.0pt" width="44" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Mean</span></span>'''</span></p> |
| − | | style="width:32.9pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width:32.9pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">SD</span></span>'''</span></p> |
| − | | style="width:33.7pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width:33.7pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Mean</span></span>'''</span></p> |
| − | | style="width:32.9pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="width:32.9pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">SD</span></span>'''</span></p> |
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| style="width:158.25pt; border:solid windowtext 1.0pt" width="214" | | | style="width:158.25pt; border:solid windowtext 1.0pt" width="214" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Flow mediated vasodilatation (%) at 30 mins</span></span>'''</span> |
| − | | style="width:31.85pt; border:solid windowtext 1.0pt" width="44" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:31.85pt; border:solid windowtext 1.0pt" width="44" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">8.14</span></span></span></p> |
| − | | style="width:32.9pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:32.9pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3.61</span></span></span></p> |
| − | | style="width:33.7pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:33.7pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3.62</span></span></span></p> |
| − | | style="width:32.9pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:32.9pt; border:solid windowtext 1.0pt" width="46" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">5.57</span></span></span></p> |
| − | | style="width:61.65pt; border:solid windowtext 1.0pt" width="84" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:61.65pt; border:solid windowtext 1.0pt" width="84" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">4.5</span></span></span></p> |
| − | | style="width:87.55pt; border:solid windowtext 1.0pt" width="120" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="width:87.55pt; border:solid windowtext 1.0pt" width="120" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">-16.2 to 25.2</span></span></span></p> |
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{| class="Table" style="border:solid windowtext 1.0pt" | {| class="Table" style="border:solid windowtext 1.0pt" | ||
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| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Non-Event Outcomes</span></span>'''</span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Time to outcome/s</span></span>'''</span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Control group</span></span>'''</span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Experimental group</span></span>'''</span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">P-value</span></span>'''</span></p> |
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| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:">Bubble Grade after provocation with cough (Eftedal and Brubakk score)</span></span>'''</span> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">30 mins</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">3</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">1</span></span></span></p> |
| − | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family: | + | | style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:">0.026</span></span></span></p> |
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| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Comments:</span></span></span>'''<br/> <span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">1. Ten individuals did the three dives in a random order with one day off between each dive.<br/> 2. Brachial arterial flow mediated dilatation (FMD) was measured using % dilatation after a five minute occlusion of flow.<br/> 3, Bubble grade data analysed by Friedman repeated measures analysis of variance.<br/> 4. FMD difference was statistically significant between 50% oxygen and either of the other two conditions by two way repeated measures ANOVA with Tukey test, P=0.03 in the paper.<br/> 5. The FMD was expected to decrease further with 99% oxygen than 50% oxygen so this finding is surprising.</span></span></span></span> |
| − | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family: | + | <span style="line-height:normal">'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Appraised by:</span></span></span>'''<span style="font-size:13.5pt"><span style="font-family:"><span style="color:black">Mike Bennett m.bennett@unsw.edu.au; Monday, 21 December 2020<br/> '''Kill or Update By:''' December 2022</span></span></span></span> |
Revision as of 02:58, 21 December 2020
50% oxygen breathing during decompression, but not 99% oxygen breathing, was associated with significantly reduced flow-mediated dilatation in the brachial artery.
Clinical bottom line
|
1. 99% oxygen decompression reduced the bubble numbers after provocation |
Citation/s:1.Ribicic IŠ, Valic M, Božic J, Obad A, Glavaš D, Glavicic I, Valic Z. Influence of oxygen enriched gases during decompression on bubble formation and endothelial function in self-contained underwater breathing apparatus diving: a randomized controlled study. Croatian medical journal. 2019 Jun;60(3):265.
Three-part Clinical Question:For rebreather divers, does altering the proportion of oxygen in the breathing gas result in any differences in venous bubbling or endothelial function?
Search Terms: Rebreather; nitrrox; venous gas embolism
The Study:Non-blinded randomised controlled trial with intention-to-treat.
The Study Patients: Fit adult experienced divers with no significant comorbidities or history of decompression illness.
Control group (N = 10; 10 analysed): Air dive to 45msw with V-planner calculated decompression stops on air for a total dive time of 65 minutes.
Experimental group (N = 10; 10 analysed): Same bottom time and depth but V-planner calculated decompression stops with 50% oxygen (from 21 msw, total dive time 45 mins) and 99% oxygen (from 6 msw and total dive time 43 mons).
The Evidence:
Measure |
Air Group |
50% oxygen Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
Flow mediated vasodilatation (%) at 30 mins |
8.14 |
3.61 |
3.62 |
5.57 |
4.5 |
-16.2 to 25.2 |
Non-Event Outcomes |
Time to outcome/s |
Control group |
Experimental group |
P-value |
|
Bubble Grade after provocation with cough (Eftedal and Brubakk score) |
30 mins |
3 |
1 |
0.026 |
Comments:
1. Ten individuals did the three dives in a random order with one day off between each dive.
2. Brachial arterial flow mediated dilatation (FMD) was measured using % dilatation after a five minute occlusion of flow.
3, Bubble grade data analysed by Friedman repeated measures analysis of variance.
4. FMD difference was statistically significant between 50% oxygen and either of the other two conditions by two way repeated measures ANOVA with Tukey test, P=0.03 in the paper.
5. The FMD was expected to decrease further with 99% oxygen than 50% oxygen so this finding is surprising.
Appraised by:Mike Bennett m.bennett@unsw.edu.au; Monday, 21 December 2020
Kill or Update By: December 2022
