David J Doolette’s research while affiliated with University of Auckland and other places

This study evaluated the relative importance of perfusion and diffusion mechanisms in compartmental models of blood : tissue helium exchange in a predominantly skeletal muscle tissue bed in the sheep hind limb. Helium has different physiochemical properties from previously studied gases and is a common diluent gas in underwater diving where decompression schedules are based on theoretical models of inert gas kinetics. Helium kinetics across skeletal muscle were determined during and after 20 min of helium inhalation, at separate resting and low steady-states of femoral vein blood flow in six sheep under isoflurane anaesthesia. Helium concentrations in arterial and femoral vein blood were determined using gas chromatographic analysis and femoral vein blood flow was monitored continuously. Parameters and model selection criteria of various perfusion-limited or perfusion-diffusion compartmental models of skeletal muscle were estimated by simultaneous fitting of the models to the femoral vein helium concentrations for both blood flow states. A model comprising two parallel perfusion-limited compartment models fitted the data well but required a 51-fold difference in relative compartment perfusion that did not seem physiologically plausible. Models that allowed a countercurrent diffusion exchange of helium between arterial and venous vessels outside of the tissue compartments provided better overall fit of the data and credible parameter estimates. These results suggest a role of arterial-venous diffusion in blood : tissue helium equilibration in skeletal muscle.

1. Perfluorocarbon emulsions have potential medical applications, particularly as temporary oxygen carriers and are likely to be coadministered with other intravenous drugs. It is possible that perfluorocarbon emulsions may alter the disposition of other drugs in the body. 2. In the present study, we examined the brain pharmacokinetics of a 5 min infusion of 100 mg lignocaine in three chronically instrumented sheep before and after the administration of a new investigational perflurocarbon emulsion (Oxygent™; Alliance Pharmaceutical, San Diego, CA, USA). 3. The rate constant for the blood : brain equilibration of lignocaine was larger after perflubron administration. This change could not be attributed to a change in brain blood flow and, therefore, may be the result of a change in the free fraction of lignocaine in the blood.

This study evaluated the relative importance of perfusion and diffusion mechanisms in compartmental models of blood:tissue helium exchange in the brain. Helium has different physiochemical properties from previously studied gases, and is a common diluent gas in underwater diving where decompression schedules are based on theoretical models of inert gas kinetics. Helium kinetics across the cerebrum were determined during and after 15 min of helium inhalation, at separate low and high steady states of cerebral blood flow in seven sheep under isoflurane anaesthesia. Helium concentrations in arterial and sagittal sinus venous blood were determined using gas chromatographic analysis, and sagittal sinus blood flow was monitored continuously. Parameters and model selection criteria of various perfusion-limited or perfusion-diffusion compartmental models of the brain were estimated by simultaneous fitting of the models to the sagittal sinus helium concentrations for both blood flow states. Purely perfusion-limited models fitted the data poorly. Models that allowed a diffusion-limited exchange of helium between a perfusion-limited tissue compartment and an unperfused deep compartment provided better overall fit of the data and credible parameter estimates. Fit to the data was also improved by allowing countercurrent diffusion shunt of helium between arterial and venous blood. These results suggest a role of diffusion in blood:tissue helium equilibration in brain.

Doolette DJ. Decompression practice and health outcome during a technical diving project. SPUMS J. 2004; 34: 189-95. Paper presented at the SPUMS ASM in Noumea, 2004) Technical divers use multiple helium/nitrogen/oxygen breathing-gas mixtures to reach depths greater than 40 metres seawater (500 kPa) using scuba. Self-assessment of health outcome by 9 divers using a validated decompression health survey followed a series of 200 technical dives to a maximum of 123 metres of fresh water. Decompression was planned using the ZH-L16 calculation procedure. Although the incidence of treated decompression sickness was only 0.1%-3.4% (95% confidence limits), high health survey scores, possibly marginal symptoms of decompression sickness, were associated with maximum diving depth greater than 90 metres.

Multi-place, hyperbaric-chamber inside attendants are at risk of decompression sickness (DCS). Attendant decompression protocols vary between facilities and there has been limited specific development or testing of these procedures. Forty-six attendants completed a health survey designed to measure decompression-related health outcome following both 490 hyperbaric exposures and 26 days of ward work without hyperbaric exposure. The risk of decompression sickness (pDCS) for each different hyperbaric schedule was calculated according to a model for oxygen decompression. The contribution of pDCS to a decompression health survey score (DHS) was assessed by linear regression. DHS was not influenced by the hyperbaric exposures and was not different to non-hyperbaric DHS. Three attendants were treated for DCS in close agreement with the calculated mean pDCS. Despite non-zero incidence of DCS, mean attendant health status was not adversely affected by these occupational hyperbaric exposures.

Isolated inner ear decompression sickness (DCS) is recognized in deep diving involving breathing of helium-oxygen mixtures, particularly when breathing gas is switched to a nitrogen-rich mixture during decompression. The biophysical basis for this selective vulnerability of the inner ear to DCS has not been established. A compartmental model of inert gas kinetics in the human inner ear was constructed from anatomical and physiological parameters described in the literature and used to simulate inert gas tensions in the inner ear during deep dives and breathing-gas substitutions that have been reported to cause inner ear DCS. The model predicts considerable supersaturation, and therefore possible bubble formation, during the initial phase of a conventional decompression. Counterdiffusion of helium and nitrogen from the perilymph may produce supersaturation in the membranous labyrinth and endolymph after switching to a nitrogen-rich breathing mixture even without decompression. Conventional decompression algorithms may result in inadequate decompression for the inner ear for deep dives. Breathing-gas switches should be scheduled deep or shallow to avoid the period of maximum supersaturation resulting from decompression.

Many occupational diving groups have substantially different diving patterns to those for which decompression schedules are validated. To evaluate tuna farm occupational diving practice against existing decompression models and describe a method for collecting and modelling self reported field decompression data. Machine readable objective depth/time profiles were obtained from depth/time recorders worn by tuna farm occupational divers. Divers' health status was measured at the end of each working day using a self administered health survey that produces an interval diver health score (DHS) with possible values ranging from 0 to 30. Depth/time profiles were analysed according to existing decompression models. The contribution of diving exposure and between diver variability to DHS was evaluated using linear regression. The mean risk of decompression sickness was calculated as 0.005 (SD 0.003, n = 383). The mean DHS following diving was 3 (SD 2, n = 383) and following non-diving activities was 1 (SD 1, n = 41). After accounting for between diver variability in intercept, DHS was found to increase one unit for every 1% increase in the risk of decompression sickness. A method has been established for the collection and analysis of self reported objective decompression data from occupational diving groups that can potentially be used as the basis for development of purpose designed occupational diving decompression schedules.

Acclimatization to decompression stress has been reported in caisson workers and helium-oxygen divers; however the alternative notion that the risk of decompression sickness increases with successive days of diving is widespread. We examined 201 multi-day series of 2 to 29 diving days identified retrospectively in a database of occupational air dives for evidence of acclimatization or sensitization. Decompression related health status was measured using a self-administered diver health survey; resulting scores were analyzed by linear modelling. Daily diving consisted of 1-3 dives each to mean maximum depth of 17.2 (SD 3.9) meters seawater for a mean duration of 23 (SD 17) min. Daily diver health scores increased with calculated daily risk of decompression sickness but were not influenced by the order of dives in multi-day series. Poor health outcome indicated by treated decompression sickness and diver health scores > 8 occurred early in multi-day series. There was no evidence of sensitization to decompression stress whereas the timing of poor health outcomes suggests an element of acclimatization.