title: Glossopharyngeal insufflation and breath-hold diving: the more, the worse?
abstract: OBJECTIVE
  The glossopharyngeal insufflation maneuver (lung packing) is largely performed by competitive breath-hold divers to improve their performance, despite observational evidence of fainting and loss of consciousness in the first seconds of apnea.
  
  
  METHODS
  We describe here the time course of hemodynamic changes, induced by breath-holding with and without lung packing, in 2 world-class apnea competitors.
  
  
  RESULTS
  When compared with apnea performed after a deep breath (100% vital capacity), lung packing leads to a decrease in cardiac output, blood pressure, and cerebral blood flow during the first seconds after the beginning of apnea. The major hemodynamic disorders were observed in diver 1, who exhibited the greater increase in pulmonary volume after lung packing (+22% for diver 1 vs +10% for diver 2). After the initial drop in both cardiac output and blood pressure, the time course of hemodynamic alterations became quite similar between the two apneas.
  
  
  CONCLUSIONS
  Some recommendations, such as limiting the number of maneuvers and performing lung packing in the supine position, should be expressed to avoid injuries secondary to the use of glossopharyngeal insufflation.
authors.affiliation: UMR-MD2, French Armed Biomedical Research Institute, IRBA, Brétigny sur Orge, and Aix-Marseille University, Marseille, France (Drs Boussuges, Bessereau, Coulange, and Rossi). Electronic address: alain.boussuges@irba.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Boussuges
authors.affiliation: Laboratoire HandiBio-EA 4322, Université du Sud Toulon Var, La Garde, France (Dr Gavarry).
authors.forename: Olivier
authors.initials: O
authors.lastname: Gavarry
authors.affiliation: UMR-MD2, French Armed Biomedical Research Institute, IRBA, Brétigny sur Orge, and Aix-Marseille University, Marseille, France (Drs Boussuges, Bessereau, Coulange, and Rossi); Pole RUSH, Assistance Publique des Hopitaux de Marseille, Marseille, France (Drs Bessereau and Coulange).
authors.forename: Jacques
authors.initials: J
authors.lastname: Bessereau
authors.affiliation: UMR-MD2, French Armed Biomedical Research Institute, IRBA, Brétigny sur Orge, and Aix-Marseille University, Marseille, France (Drs Boussuges, Bessereau, Coulange, and Rossi); Pole RUSH, Assistance Publique des Hopitaux de Marseille, Marseille, France (Drs Bessereau and Coulange).
authors.forename: Mathieu
authors.initials: M
authors.lastname: Coulange
authors.affiliation: Massiliasub, Marseille, France (Mr Bourc'his).
authors.forename: Morgan
authors.initials: M
authors.lastname: Bourc'his
authors.affiliation: UMR-MD2, French Armed Biomedical Research Institute, IRBA, Brétigny sur Orge, and Aix-Marseille University, Marseille, France (Drs Boussuges, Bessereau, Coulange, and Rossi); Internal Medicine Department, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France (Dr Rossi).
authors.forename: Pascal
authors.initials: P
authors.lastname: Rossi
mesh_terms: D000328:Adult; D001049:Apnea / Q000503:physiopathology*; D062485:Breath Holding; D002302:Cardiac Output; D004242:Diving / Q000502:physiology*; D005541:Forced Expiratory Volume; D005930:Glossopharyngeal Nerve / Q000503:physiopathology*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D007327:Insufflation; D008168:Lung / Q000503:physiopathology
keywords: apnea; cardiac function; cerebral blood flow; echocardiography; heart lung interaction; immersion pulmonary edema; transcranial Doppler ultrasound