SPUMS: Joint position statement on atrial shunts and diving, Update 2025<\/a><\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.27.5″ _module_preset=”default” global_colors_info=”{}”]<\/p>\n
What could be<\/h3>\n
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The statement “it’s simply just age and body fat” probably falls short, even if other factors are really hard to prove. Fundamentally, it is very likely that general fitness and overall health also have an influence on how high the risk is that a dive ends with DCS. The problem is: to determine more precisely how much influence which factors have exactly, data is simply lacking. <\/p>\n
Pre-existing conditions, chronic inflammatory processes, endothelial dysfunction, scar tissue, individual differences in the immune system\u2014all these are factors for which there is good evidence that they influence how the body reacts to decompression stress. They could explain why bubbles remain silent in some people and trigger symptoms in others. <\/p>\n
This entire complex of topics has been researched under the keyword “individual decompression” for many years. This is linked to the hope that divers can better understand exactly where their individual stress limit lies. Perhaps there will be new insights in this area in the coming years\u2014for the moment, we unfortunately have to accept that much here remains unclear. <\/p>\n
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Diving conditions<\/h2>\n
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What verifiably reduces the risk<\/h3>\n
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Lower supersaturation = lower risk<\/h4>\n
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It sounds banal, but: Yes, the biggest risk factor can be read from the dive profile. Unfortunately, not in a way that one could clearly say which profile will result in DCS\u2014at least not if you dive within recognized limits. But: deeper, longer, and a higher maximum Gradient Factor reached statistically lead to slightly more DCS cases.
The higher the supersaturation, the greater the risk of DCS occurring. This is not just about dives where limits were ignored, but about the normal supersaturation that is accepted when diving. Most DCS cases in the DAN database occur during dives where Gradient Factors between 70 and 90 were reached\u2014i.e., during recreational dives well within no-deco limits. At GFs below 60, DCS occurs only extremely rarely.
There is a separate blog post with more on the topic of Gradient Factors. <\/p>\n
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The thing about the cold<\/h4>\n
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And then there’s the cold. This is one of the rare cases where the data situation is unusually clear. Studies by the U.S. Navy Experimental Diving Unit have shown that cold during decompression significantly increases the risk of DCS. The classic scenario is particularly problematic: warm at the bottom, cold during the ascent and at the stops. <\/p>\n
The mechanism is easy to understand. Warmth at the bottom leads to good blood flow in the periphery and thus to higher inert gas uptake in these tissues. If it gets cold during decompression, the vessels constrict, blood flow to the extremities decreases, and that is exactly where the removal of the gas is hindered. Supersaturations rise, and bubble formation becomes more likely. <\/p>\n
Conversely, the effect is also relevant: cold during gas uptake and warm during decompression is significantly more favorable. Cold is thus one of the few risk factors that are really clearly verifiable. <\/p>\n
But what to do? Most divers know that it gets a bit chilly at the end of a dive, even in tropical waters. When the dive is more demanding than just looking at fish in shallow water, it makes sense to think about adequate thermal protection. This could be a slightly thicker suit, or a heated vest under the drysuit that you turn on specifically at the end of the dive. <\/p>\n
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What could be<\/h3>\n
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Exertion<\/h4>\n
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Not quite as clear, but still very likely, is the connection between workload during diving and DCS. The database shows that with current and exertion underwater, the risk of getting DCS increases. Not dramatically, but measurably.
This also has a certain logic, especially if the exertion decreases towards the end of the dive. If you swim with more effort, move more, and increase circulation during the phase in which you absorb inert gases, nitrogen is better distributed in the body. If you then rest a bit more at the end of the dive, the body behaves differently in the desaturation phase than in the saturation phase and tends to eliminate less nitrogen. And that can bring you closer to critical limits. <\/p>\n
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Nitrox<\/h4>\n
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Many people firmly believe that diving with Nitrox is safer. Fundamentally, one thing is true: if you do the same dive with Nitrox as with air, you come out of the water with lower supersaturation, so the dive is safer. But this only applies in comparison to the exact same dive with air. Since Nitrox is often used to enjoy longer no-deco times, diving with Nitrox does not automatically become safer. Statistically, at least, no difference in DCS risk can be detected between air dives and those with Nitrox. <\/p>\n
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What is overrated….<\/h3>\n
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Order<\/h4>\n
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“Deepest dive first” is a concept that persists extremely stubbornly and is sometimes enforced in almost absurd ways. On a liveaboard, you MUST go deep on the first dive because the second one is on a wreck at 30m, and the first one just has to be deeper\u2014as if it wouldn’t be safer to keep the total saturation lower throughout the day. Or in the case of DCS, the accusation arises as to why the second dive was made deeper than the first\u201418m as the second, 6m as the first… well….
This is actually a myth. The order of the dives doesn’t matter\u2014the decompression simply becomes longer, or the no-deco limits shorter, if there is already pre-saturation. If you want to have as much time as possible at depth, it is more efficient to do the deepest dive without pre-saturation. But that’s all. <\/p>\n
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Behavior around the dive<\/h2>\n
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What we think we know<\/h3>\n
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Especially when it comes to what you should do or avoid before and after diving, there are many strong opinions. Dehydration is said to be so dangerous, you have to drink a lot, and better not do sports, and under no circumstances should you take a hot shower after diving!
The problem with this: we actually know much less about all these factors than the opinions would suggest. Studies are often contradictory, not statistically significant, and it is difficult to find out which factors contributed to the development of DCS symptoms and to what extent. Here, too, the “problem” lies in the fact that DCS is rare, and therefore little data is available.
For some behaviors, it can be well argued that they could represent a risk factor\u2014but nothing more. <\/p>\n
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Potentially critical<\/h3>\n
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Exertion after diving<\/h4>\n
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Coming out of the water and immediately lugging lots of heavy equipment around? Technical divers in particular are inclined to exercise caution here. If many tanks have to be taken out of the water, perhaps even carried a bit further, this can be a risk factor. During great exertion, gas bubbles could pass through shunts in the heart or lungs and promote the development of DCS symptoms. Even if there are no clear studies on this, the idea is plausible enough to prefer carrying one tank after another very slowly…
Demanding sporting activities after diving should also probably be viewed with some caution. Boosting the circulation leads to increased blood flow, nitrogen is released faster, and this could make the desaturation process a bit too aggressive. So maybe just no more marathons on the same day, but there is really nothing against a walk. <\/p>\n
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Dehydration<\/h4>\n
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No one knows exactly when this topic became so relevant among divers\u2014but the belief that dehydration is one of the main causes of DCS is extremely widespread.
A few facts on this: Yes, diving dehydrates. You lose an average of nearly one liter of water during a dive; with several dives a day, it becomes a bit less. Therefore, you tend to be slightly dehydrated after diving\u2014whether you get DCS or not.
Studies have shown that people who drink nothing before diving develop more bubbles than those who drink appropriately. But: even if you drink too much, more bubbles develop. So one cannot speak of a clear result here. <\/p>\n
Drinking too much water also carries risks, as it can upset the electrolyte balance in the body. So it is certainly sensible to drink enough, especially in regions with a hot, dry climate\u2014but the connection between dehydration and DCS is by far not as clear as is often claimed. <\/p>\n
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And what do I make of that?<\/h3>\n
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If you take all of this together, a sober core remains. DCS arises from critical supersaturation, but exactly where the limit is exceeded for a specific person on a specific day is not known in advance. Cold during decompression is an unusually clear risk enhancer, workload is relevant, and age and body composition also shift the risk. But a large part of the risk lies in biological factors that we currently cannot reliably measure or control. <\/p>\n
Perhaps this is the most important point of all: not to moralize DCS, neither in oneself nor in others. We don’t know the risk factors exactly, so you can’t name a cause if someone happens to get DCS. Let’s just accept that diving\u2014like any serious activity\u2014carries a residual risk, and talk about it without blame or the desperate search for a reason. <\/p>\n
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Further reading<\/h2>\n
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Cialoni 2017: Dive Risk Factors, Gas Bubble Formation, and Decompression Illness in Recreational SCUBA Diving: Analysis of DAN Europe DSL Data Base<\/p>\n
[\/et_pb_blurb][\/et_pb_column][et_pb_column _builder_version=”4.27.6″ _module_preset=”default” type=”1_3″][et_pb_blurb title=”NEDU Cold Study” _builder_version=”4.27.6″ _module_preset=”cd0bdbae-d9d8-4b43-9d1f-98137af1254b” url=”https:\/\/apps.dtic.mil\/sti\/citations\/ADA480570″ url_new_window=”on” link_option_url=”https:\/\/apps.dtic.mil\/sti\/citations\/ADA480570″ link_option_url_new_window=”on” hover_enabled=”0″ sticky_enabled=”0″ use_icon=”on” icon_placement=”left” font_icon=”h||divi||400″]<\/p>\n
Gerth 2007: The Influence of Thermal Exposure on Diver Susceptibility to Decompression Sickness<\/p>\n
[\/et_pb_blurb][\/et_pb_column][et_pb_column _builder_version=”4.27.6″ _module_preset=”default” type=”1_3″][et_pb_blurb title=”DCS cases in different diving conditions” _builder_version=”4.27.6″ _module_preset=”cd0bdbae-d9d8-4b43-9d1f-98137af1254b” url=”https:\/\/pubmed.ncbi.nlm.nih.gov\/32176949\/” url_new_window=”on” link_option_url=”https:\/\/pubmed.ncbi.nlm.nih.gov\/32176949\/” link_option_url_new_window=”on” hover_enabled=”0″ sticky_enabled=”0″ use_icon=”on” icon_placement=”left” font_icon=”h||divi||400″]<\/p>\n
Dunford 2020: A study of decompression sickness using recorded depth-time profiles<\/p>\n
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