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Oxygen Toxicity: Too much of a good thing.

Oxygen is necassary for life, but as divers we are exposed to higher partial pressures of oxygen (pO2 or ppO2) than normal. A partial Dr Oliver Sykespressure is simply the fraction of the total pressure that an individual gas takes up in a mixture of gases. Therefore 21% oxygen at sea level has a pO2 of 0.21 bar.

There are 2 main types of oxygen toxicty that we need to limit, which are pulmonary (lung) and neurological oxygen toxicity. In order to obtain energy from food, oxygen is used to break strong molecular bonds at the cellular level and is necessarily a fairly reactive species. As humans, we have evolved to use oxygen at 0.21 bar and even a pO2 of 0.5 bar begins to overwhelm the body’s repair mechanisms very slightly. This pO2 is only 50% O2 at sea level or 25% O2 at 2 bar or 10m. Therefore 50% oxygen is not recommended for over 24hrs in healthcare settings due to lung oxygen toxicity. Unless absolutely necassary. With much larger increases over shorter periods, such as a pO2 of over 1.4 bar during diving, neurological oxygen toxicity becomes the main worry. This is manifested in violent fitting (uncontrolled movements of the arms and legs) and is often fatal when diving. Unfortunately drowning is common and ascent is dangerous due lung barotrauma from a closed wind pipe. Therefore even a full face mask is not safe and the only treatment is to reduce the high pO2. Unfortunately stressors make neurological oxygen toxicity more likely during diving and include exercise, cold, poor vis, nitrogen narcosis, raised blood carbon dioxide levels and psychological stress. These are present on all dives and for everyone to some degree.

During recompression treatment, the chamber environment does not risk drowning and we minimise the stressors. We also use air breaks to limit the time spent at high pO2 levels and therefore use 100% O2 to greater depths than in water.

Overall, neurological oxygen toxicity is a very rare event in chambers and simply requires the diver to be taken off oxygen. Given that recompression is a treatment, the additional risk from oxygen toxicity is therefore acceptable and the pO2 limit is significantly higher in chamber treatments. But only with good reason.

 

Question 1:

What do you do if a diver fits underwater?

100% O2 should not be breathed below 4-6m, as this gives a pO2 of 1.4 to 1.6 bar. If a diver is using breathing gas mixes enriched with oxygen and then fits at depth, the cause is likely to be oxygen toxicity and switching to the wrong mix can cause this. Ascent is clearly dangerous due to lung over expansion injury, but may be the only way to ensure help can be given. Make sure you are aware of this problem and are able to cope with it. Essentially, follow the guidence from your training agency at all times.

 

Question 2:

Are there any preceding symptoms prior to an oxygen toxicty fit?

Yes there are. These include blurred vision, ringing in the ears, nausea, twitching, irritability (anxiety, restlessness) and dizziness, which can progress to convulsions (fitting). These can be remembered with the letters VENTID-C  and can be difficult to pick up when diving. (Vision, Ears, Nausea, Twitching, Irritability, Dizziness, Convulsions)

 

Question 3:

What happens if someone has an oxygen fit in the chamber?

Our chamber attendants are trained to recognise the preceding symptoms and will take the diver off oxygen. If there is a convulsion, then they will pad the moving limbs and the fit will stop once off oxygen. Chamber pressure must not be altered during a fit. There is no long term damage, it is not epilepsy and has no impact on future diving or driving. We would then decide whether to continue the treatment or shorten it, depending on the reason for treatment and the state of the patient.

 

Question 4:

What is pulmonary (lung) oxygen toxicity?

The airways become narrower as a result of inflammation. There is often midline chest pain, cough and reduced lung function tests. Diving is unlikely to produce sufficient oxygen exposure. However some of the more extensive treatments for decompression illness may cause a degree of pulmonary oxygen toxicty. Thankfully this is often completely reversible.

 

Question 5:

Are air breaks useful in preventing oxygen toxicity at sea level?

Important: Do not use air breaks when using oxygen at the surface in an emergency situation, this is unnecessary and deprives the diver of a very important treatment.

 

A video from Divers Alert Network DAN follow the link below :

CNS Oxygen Toxicity – Richard Vann PhD