Understanding the conclusion of a comparative evaluation of two decompression procedures for technical diving using inflammatory responses: Compartmental versus Ratio Deco.

First, immunology isn’t a completed understood field, is an area of active research and still discovering its working mechanism. Keeping that in mind, I’m going to help you understand the concepts of this study.

Figure 1

Figure 1

The conclusion of this study was based on inflammatory response to decompression, which is an indicator of how the organism react to bubbles formation.

For those without medical knowledge (most of us), you may say that the body treats bubbles as an infection or as a foreign body 1,2.

The Chemokines are used in the study as indicators of a good decompression. Why?

Bubbles on the bloodstream are treated by the organisms as a foreigner body or infection, thus, Chemokines served as indicator of the immune response to an inflation caused by the bubbles.

Their (chemokines) main function is recruited glucoside- white blood cells out of the bloodstream when an infection is present. From the blood into the interstitial fluid where they can fight the invading pathogen that is causing the inflammatory responses. These Chemokines will interact with receptors at the surface of the glucosides causing adhesion of these cells to the apical membrane of the endothelial cells.

In the figure 1, you may observe a blood vessel, the exchange of gases and others nutrients which is at normal state. All blood vessels have the same basic structure. These vessels are designed to transport nutrients and oxygen to the tissues of the body. They also take waste and carbon dioxide and carry them away from the tissues and back to the heart.

Now on the Figure 2, you can observe what will happened when an intruder, a bubble is present.

 

Figure 2

Figure 2

Simplifying things, the tissues cells that are in contact with the bubble, start releasing chemicals that are essentially messenger. These are chemokines. The mast cells are activated by direct contact or it could be for the chemokines signaling. The mast cells release histamine, one of the main actors and byproduct of the inflammatory process. This’s the first line of defense. So histamine made the capillaries larger, called dilation. And this made some of the swelling. At this stage, fluid is building up.

Once separated the endothelial cells, the opened wall let pass the neutrophil and proteins cells that will try to eat the foreign body. The fluid passing throughout the vessel wall is called exuded. And that is why we can watch the macro symptoms at tissue level; which are: redness, swelling, heat and pain.

What could happen with the bubble is that it could became encapsulated it, stopping blood to flow in that area.

I hope this explanation served you to understand why they used chemokines as an indicator.

Regarding the conclusion of this study, one interesting fact is that applying deep stop procedural into our decompression may not be the best alternative. On my opinion, deep stops should be included in the algorithm and not as external procedure calculation.

Remember that there is a big difference between algorithm, like the Thalmann algorithm or Bühlmann , which are compartmental algorithms and a procedure, like Ratio Deco. In any case, knowing Ratio is a good sources of comparison and some procedure could be included in with safety.

At the end, what is in question is how beneficial and for how long should deep stop be performed.

1 not normal or usual to a place.
2 In immunology, pertaining to substances not recognized as “self” and capable of inducing an immune response.foreign body reaction a granulomatous inflammatory response evoked by the presence of a foreign body in thetissues; a characteristic feature of this is the formation of foreign body giant cells (see giant cell).

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