title: Flying after diving: in-flight echocardiography after a scuba diving week.
abstract: BACKGROUND
  Flying after diving may increase decompression sickness risk (DCS), but strong evidence indicating minimum preflight surface intervals (PFSI) is missing.
  
  
  METHODS
  On return flights after a diving week on a live-aboard, 32 divers were examined by in-flight echocardiography with the following protocol: 1) outgoing flight, no previous dive; 2) during the diving week; 3) before the return flight after a 24-h PFSI; and 4) during the return flight.
  
  
  RESULTS
  All divers completed similar multiple repetitive dives during the diving week. All dives were equivalent as to inert gas load and gradient factor upon surfacing. No bubbles in the right heart were found in any diver during the outgoing flight or at the preflight control after a 24-h PFSI following the diving week. A significant increase in the number and grade of bubbles was observed during the return flight. However, bubbles were only observed in 6 of the 32 divers. These six divers were the same ones who developed bubbles after every dive.
  
  
  CONCLUSIONS
  Having observed a 24-h preflight interval, the majority of divers did not develop bubbles during altitude exposure; however, it is intriguing to note that the same subjects who developed significant amounts of bubbles after every dive showed equally significant bubble grades during in-flight echocardiography notwithstanding a correct PFSI. This indicates a possible higher susceptibility to bubble formation in certain individuals, who may need longer PFSI before altitude exposure after scuba diving.
authors.affiliation: DAN Europe Research Division, Roseto degli Abruzzi, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Cialoni
authors.forename: Massimo
authors.initials: M
authors.lastname: Pieri
authors.forename: Costantino
authors.initials: C
authors.lastname: Balestra
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marroni
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D000531:Altitude; D003665:Decompression Sickness / Q000000981:diagnostic imaging* / Q000209:etiology; D004242:Diving / Q000009:adverse effects* / Q000502:physiology; D015150:Echocardiography, Doppler; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors