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by Peter Buzzacott
Most technical divers understand and know how to calculate their Surface Air Consumption (SAC) rate, which is typically used in gas planning. But did you know that SAC rates can also be used to measure various workloads—for example, the difference in workload when diving doubles vs. singles, using various techniques, or under different environmental conditions?
Let’s use an example to recap the theory; I’ll use metric throughout this blog for simplicity. A diver is at 10m depth, which is 2 ATA in the sea. The diver’s tank is a standard 12-liter tank filled with 200 bars (plus a safety margin); therefore the diver has 2,400 usable liters of gas at the surface. At 10m depth, that would be down to 1,200 breathable liters, and if the diver used the whole 1,200 L of usable gas over one hour, then the diver’s surface equivalent breathing rate would be 1,200/60, which is 20 liters per minute—a common, if slightly high, breathing rate. One might argue the actual breathing rate is 40 liters per minute, and that the equivalent of 40 liters per minute comes out of the tank, but it is actually compressed down to 20 liters because the diver is at 2 ATA. This is why we call it surface air consumption— because even though the breathing gas is twice as dense at 10 meters depth, the breathing rate is equivalent to 20 L/min at the surface (not 40 L/min at the surface). Of course, the air is twice as dense, so the work of breathing is greater, but SAC does not account for this.
Okay, that’s the math out of the way. In the real world, divers often use the average depth from their dive computers to estimate the average ambient pressure throughout the dive, then divide the volume of gas used by the number of minutes spent underwater and the average pressure. This gives a fairly accurate estimate of the surface equivalent breathing rate. For part of my PhD research, I clipped accurate depth loggers to the chest D-rings of divers and recorded over 1,000 recreational dives. I also used a calibrated pressure gauge to measure the tank pressure before and after each dive, and noted the tank volume stamped on each tank. Then, I asked every diver if they thought the workload during their dive was “resting/light,” “moderate,” or “severe/exhausting.”
Good in the SAC?
In the 1980s, a scientist named Dwyer had divers fin at a certain pace against a set resistance and measured both their SAC and how much oxygen remained in their exhaled gas. This was done at a few set depths, including a series of dives at 10m depth. An equation was generated for each depth to convert SAC into oxygen consumption. The mean depth of my 1,000 recorded dives was 10.7 m, so I used Dwyer’s 10m equation to convert everyone’s SAC into oxygen consumption. I then made one last conversion by dividing everyone’s oxygen consumption by their weight (in kilograms, of course). This standardized the oxygen consumption across the whole range of divers, from small to large and whether male or female.
Interested readers can read my paper, but to make the results meaningful here, I’ll compare the dives by how many metabolic equivalents (METS, i.e., the rate at which a person expends energy relative to the mass or weight of that person) each dive represented. When our oxygen consumption is at its lowest, for example, when we are asleep, we consume around 3.5 ml/kg.min of oxygen, which is by convention considered to be 1 MET. If I consume 35 ml/kg.min of oxygen while running on the treadmill, then I would be running at 10 METS.
In my study, the divers who said their dive was relaxing had an average workload of 5.3 METS. It is important to remember that is an average, because some people had a very low SAC and some people really chewed through their gas, but the average for a resting dive was 5.3 METS, which is about the same as a brisk walk. The dives with a moderate workload averaged 5.8 METS, which is about the same as riding a bicycle at a modest pace (~15 km/hr), and the severe/exhausting dives averaged 6.2 METS, which is about the same workload intensity as an aerobics class.
Dwyer also recorded his divers’ heart rates and tried to generate equations to link SAC with heart rate. Recently I tried something similar and took a research team to Oregon to measure SAC and heart rate in volunteer divers at the Oregon Coast Aquarium. We fitted waterproof EKGs to each diver, plus those sensitive depth/time loggers, and estimated their workload just as I’d described above. But, just like Dwyer, we couldn’t generate a reliable conversion from SAC to heart rate, or vice versa. Therefore, the most reliable estimate of workload that we divers have is, in my opinion, SAC/kg. To give some sort of guide, the “resting/light” divers in my PhD research had an average SAC/kg of 0.21 L/kg.min, the moderate divers 0.23 L/kg.min, and the exhausted divers 0.29 L/kg.min.
As we all know, good trim is essential for reducing workload while diving—as is correct weighting and good buoyancy control. Other factors include finning technique and drag. Using SAC/kg, divers can measure for themselves how much of an effect there is when going from a single tank to a set of doubles, or when adding a stage or multiple stages. Divers can also see just how much of an improvement they make when they perfect their technique over many dives—for example, their DPV technique. [ed: It’s OK to try this at home kids!]
Another advantage of SAC/kg is that it can be compared within a dive team between males and females, between small divers and big divers. In Oregon, the aquarium divers were in drysuits, the water was cold, and the divers were working (cleaning the viewing windows, vacuuming the floor, etc). Their average SAC/kg was 0.26 L/kg.min, which was equivalent to a moderate-to-difficult workload. The full paper was published in the latest issue of Occupational Medicine.
Buzzacott P, Pollock NW, Rosenberg M. Exercise intensity inferred from air consumption during recreational scuba diving. Diving and Hyperbaric Medicine. 2014;44:74-8.
Dwyer J. Estimation of oxygen uptake from heart rate response to undersea work. Undersea Biomedical Research. 1983;10:77-87.
Buzzacott P, Grier JW, Walker J, Bennett CM, Denoble PJ. Estimated workload intensity during volunteer aquarium dives. Occupational Medicine. 2019; https://doi.org/10.1093/occmed/kqz011
Peter Buzzacott, MPH, PhD, is a former recreational and technical diving instructor, now a university researcher with more than 60 published papers on diving injuries. He is a Guest Professor at the Second Military Medical University in Shanghai, in the hyperbaric research laboratory that, in 2017, discovered the first nutritional supplement shown to prevent decompression sickness. Before that, he conducted decompression experiments during a two-year post-doctoral fellowship at a university in northern France. He is an avid cave diver.
Understanding Oxygen Toxicity: Part 1 – Looking Back
In this first of a two-part series, Diver Alert Network’s Reilly Fogarty examines the research that has led to our current working understanding of oxygen toxicity. He presents the history of oxygen toxicity research, our current toxicity models, the external risk factors we now understand, and what the future of this research will look like. Mind your PO2s!
By Reilly Fogarty
Header photo courtesy of DAN
Oxygen toxicity is a controversial subject among researchers and an intimidating one for many divers. From the heyday of the “voodoo gas” debates in the early 1990s to the cursory introduction to oxygen-induced seizure evolution that most divers receive in dive courses, the manifestations of prolonged or severe hyperoxia can often seem like a mysterious source of danger.
Although oxygen can do great harm, its appropriate use can extend divers’ limits and improve the treatment of injured divers. The limits of human exposure are tumultuous, often far greater than theorized, but occasionally–and unpredictably–far less.
Discussions of oxygen toxicity refer primarily to two specific manifestations of symptoms: those affecting the central nervous system (CNS) and those affecting the pulmonary system. Both are correlated (by different models) to exposure to elevated partial pressure of oxygen (PO2). CNS toxicity causes symptoms such as vertigo, twitching, sensations of abnormality, visual or acoustic hallucinations, and convulsions. Pulmonary toxicity primarily results in irritation of the airway and lungs and decline in lung function that can lead to alveolar damage and, ultimately, loss of function.
The multitude of reactions that takes place in the human body, combined with external risk factors, physiological differences, and differences in application, can make the type and severity of reactions to hyperoxia hugely variable. Combine this with a body of research that has not advanced much since 1986, a small cadre of researchers who study these effects as they pertain to diving, and an even smaller group who perform research available to the public, and efforts to get a better understanding of oxygen toxicity can become an exercise in frustration.
Piecing together a working understanding involves recognizing where the research began, understanding oxygen toxicity (and model risk for it) now, and considering the factors that make modeling difficult and increase the risk. This article is the first in a two-part series. It will cover the history of oxygen toxicity research, our current models, the external risk factors we understand now, and what the future of this research will look like.
After oxygen was discovered by Carl Scheele in 1772, it took just under a century for researchers to discover that, while the gas is necessary for critical physiological functions, it can be lethal in some environments. The first recorded research on this dates back to 1865, when French physiologist Paul Bert noted that “oxygen at a certain elevation of pressure, becomes formidable, often deadly, for all animal life” (Shykoff, 2019). Just 34 years later, James Lorrain Smith was working with John Scott Haldane in Belfast, researching respiratory physiology, when he noted that oxygen at “up to 41 percent of an atmosphere” was well-tolerated by mice, but at twice that pressure mouse mortality reached 50 percent, and at three times that pressure it was uniformly fatal (Hedley-White, 2008).
Interest in oxygen exposure up to this point was largely medical in nature. Researchers were physiologists and physicians working to understand the mechanics of oxygen metabolism and the treatment of various conditions. World War II and the advent of modern oxygen rebreathers brought the gas into the sights of the military, with both Allied and Axis forces researching the effects of oxygen on divers. Chris Lambertsen developed the Lambertsen Amphibious Respiratory Unit (LARU), a self-contained rebreather system using oxygen and a CO2 absorbent to extend the abilities of U.S. Army soldiers, and personally survived four recorded oxygen-induced seizures.
Kenneth Donald, a British physician, began work in 1942 to investigate cases of loss of consciousness reported by British Royal Navy divers using similar devices. In approximately 2,000 trials, Donald experimented with PO2 exposures of 1.8 to 3.7 bar, noting that the dangers of oxygen toxicity were “far greater than was previously realized … making diving on pure oxygen below 25 feet of sea water a hazardous gamble” (Shykoff, 2019). While this marked the beginning of the body of research that resembles what we reference now, Donald also noted that “the variation of symptoms even in the same individual, and at times their complete absence before convulsions, constitute[d] a grave menace to the independent oxygen-diver” (Shykoff, 2019). He made note not just of the toxic nature of oxygen but also the enormous variability in symptom onset, even in the same diver from day to day.
The U.S. Navy Experimental Diving Unit (NEDU), among other groups in the United States and elsewhere, worked to expand that understanding with multiple decades-long studies. These studies looked at CNS toxicity in: immersed subjects with a PO2 of less than 1.8 from 1947 to 1986; pulmonary toxicity (immersed, with a PO2 of 1.3 to 1.6 bar, and dry from 1.6 to 2 bar) from 2000 to 2015; and whole-body effects of long exposures at a PO2 of 1.3 from 2008 until this year.
The Duke Center for Hyperbaric Medicine and Environmental Physiology, the University of Pennsylvania, and numerous other groups have performed concurrent studies on similar topics, with the trend being a focus on understanding how and why divers experience oxygen toxicity symptoms and what the safe limits of oxygen exposure are. Those limits have markedly decreased from their initial proposals, with Butler and Thalmann proposing a limit of 240 minutes on oxygen at or above 25 ft/8 m and 80 minutes at 30 ft/9 m, to the modern recommendation of no greater than 45 minutes at a PO2 of 1.6 (the PO2 of pure oxygen at 20 ft/6 m).
Between 1935 and 1986, dozens of studies were performed looking at oxygen toxicity in various facets, with exposures both mild and moderate, in chambers both wet and dry. After 1986, these original hyperbaric studies almost universally ended, and the bulk of research we have to work with comes from before 1986. For the most part, research after this time has been extrapolated from previously recorded data, and, until very recently, lack of funding and industry direction coupled with risk and logistical concerns have hampered original studies from expanding our understanding of oxygen toxicity.
Primary Toxicity Models
What we’re left with are three primary models to predict the effects of both CNS and pulmonary oxygen toxicity. Two models originate in papers published by researchers working out of the Naval Medical Research Institute in Bethesda, Maryland, in 1995 (Harabin et al., 1993, 1995), and one in 2003 from the Israel Naval Medical Institute in Haifa (Arieli, 2003). The Harabin papers propose two models, one of which fits the risk of oxygen toxicity to an exponential model that links the risk of symptom development to partial pressure, time of exposure, and depth (Harabin et al., 1993). The other uses an autocatalytic model to perform a similar risk estimate on a model that includes periodic exposure decreases (time spent at a lower PO2). The Arieli model focuses on many of the same variables but attempts to add the effects of metabolic rate and CO2 to the risk prediction. Each of these three models appears to fit the raw data well but fails when compared to data sets in which external factors were controlled.
The culmination of all this work and modeling is that we now have a reasonable understanding of a few things. First, CNS toxicity is rare at low PO2, so modeling is difficult but risk is similarly low. Second, most current models overestimate risk above a PO2 of 1.7 (Shykoff, 2019). This does not mean that high partial pressures of oxygen are without risk (experience has shown that they do pose significant risk), but the models cannot accurately predict that risk. Finally, although we cannot directly estimate risk based on the data we currently have, most applications should limit PO2 to less than 1.7 bar (Shykoff, 2019).
For the majority of divers, the National Oceanic and Atmospheric Administration’s (NOAA) oxygen exposure recommendations remain a conservative and well-respected choice for consideration of limitations. The research we do have appears to show that these exposure limits are safe in the majority of applications, and despite the controversy over risk modeling and variability in symptom evolution, planning dives using relatively conservative exposures such as those found in the NOAA table provides some measure of safety.
The crux of the issue in understanding oxygen toxicity appears to be the lack of a definitive mechanism for the contributing factors that play into risk predictions. There is an enormous variability of response to hyperoxia among individuals–even between the same individuals on different days. There are multiple potential pathways for injury and distinct differences between moderate and high PO2 exposures, and the extent of injuries and changes in the body are both difficult to measure and not yet fully understood.
Interested in the factors that play into oxygen toxicity risk and what the future of this research holds? We’ll cover that and more in the second part of this article in next month’s edition of InDepth.
- Shykoff, B. (2019). Oxygen Toxicity: Existing models, existing data. Presented during EUBS 2019 proceedings.
- Hedley-Whyte, John. (2008). Pulmonary Oxygen Toxicity: Investigation and Mentoring. The Ulster Medical Journal 77(1): 39-42.
- Harabin, A. L., Survanshi, S. S., & Homer, L. D. (1995, May). A model for predicting central nervous system oxygen toxicity from hyperbaric oxygen exposures in humans.
- Harabin, A. L., Survanshi, S. S. (1993). A statistical analysis of recent naval experimental diving unit (NEDU) single-depth human exposures to 100% oxygen at pressure. Retrieved from https://apps.dtic.mil/dtic/tr/fulltext/u2/a273488.pdf
- Arieli, R. (2003, June). Model of CNS O2 toxicity in complex dives with varied metabolic rates and inspired CO2 levels.
- NOAA Diving Manual. (2001).
Two Fun (Math) Things:
CALCULATOR FOR ESTIMATING THE RISK OF PULMONARY OXYGEN TOXICITY by Dr. Barbara Shykoff
Reilly Fogarty is a team leader for risk mitigation initiatives at Divers Alert Network (DAN). When not working on safety programs for DAN, he can be found running technical charters and teaching rebreather diving in Gloucester, MA. Reilly is a USCG licensed captain whose professional background includes surgical and wilderness emergency medicine as well as dive shop management.
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