Exogenous Nitric Oxide may reduce bubble formation in both wet and dry divers.

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, 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 2008
Email: m.bennett@unsw.edu.au
Kill or Update By: August 2009