The decompression of a diver is the reduction in ambient pressure experienced during ascent from depth or depressurisation of a diving chamber. It is also the process of elimination of dissolved metabolically inert gases from the diver's body tissues which accumulated during the dive. Gas elimination also occurs during pauses in the ascent known as decompression stops, where the pressure is held constant, and after surfacing, until the gas concentrations reach equilibrium. Divers breathing gas at ambient pressure need to ascend at a rate determined by their recent exposure to pressure and the breathing gas in use. A diver who only breathes gas at atmospheric pressure when free-diving or snorkelling will not usually need to decompress. Divers using an atmospheric diving suit do not need to decompress as they are never exposed to high ambient pressure.
When an ambient pressure diver descends in the water, the hydrostatic pressure, and therefore the ambient pressure, rises. Because breathing gas is supplied at ambient pressure, some of this gas dissolves into the diver's blood and is transferred by the blood to other tissues where it may accumulate by diffusion. Inert gas such as nitrogen or helium continues to be taken up until the gas dissolved in the diver is in a state of equilibrium with the breathing gas in the diver's lungs, at which point the diver is saturated for that depth and breathing mixture, or the depth, and therefore the pressure, is changed, or the partial pressures of the gases are changed by modifying the breathing gas mixture. During ascent, the ambient pressure is reduced, and at some stage the inert gases dissolved in any given tissue will be at a higher concentration than the equilibrium state and start to diffuse out again to the blood and be eliminated in the lungs. If pressure reduction occurs too quickly, this excess gas may form bubbles, which may lead to decompression sickness, a possibly debilitating or life-threatening condition. It is essential that divers manage their decompression to avoid excessive bubble formation and decompression sickness. A mismanaged decompression usually results from reducing the ambient pressure too quickly for the amount of gas in solution to be eliminated safely. These bubbles may block arterial blood supply to tissues or directly cause tissue damage. If the decompression is effective, the asymptomatic venous microbubbles present after most dives are eliminated from the diver's body in the alveolar capillary beds of the lungs. If they are not given enough time, or more bubbles are created than can be eliminated safely, the bubbles grow in size and number causing the symptoms and injuries of decompression sickness. The immediate goal of controlled decompression is to avoid development of symptoms of bubble formation in the tissues of the diver, and the long-term goal is to avoid complications due to sub-clinical decompression injury.
The mechanisms of bubble formation and the damage bubbles cause has been the subject of medical research for a considerable time and several hypotheses have been advanced and tested. Tables and algorithms for predicting the outcome of decompression schedules for specified hyperbaric exposures have been proposed, tested and used, and in many cases, superseded. Although constantly refined and generally considered acceptably reliable, the actual outcome for any individual diver remains slightly unpredictable. Although decompression retains some risk, this is now generally considered acceptable for dives within the well tested range of normal recreational and professional diving.
Decompression may be continuous or staged. A staged decompression ascent is interrupted by decompression stops at specified depth intervals, but the entire ascent is actually part of the decompression and the ascent rate is important for harmless elimination of inert gas. A no-decompression dive, or more accurately, a dive with no-stop decompression, relies on limiting the ascent rate for avoidance of excessive bubble formation in the fastest tissues. The elapsed time at surface pressure immediately after a dive is known as the surface interval, is also an important part of decompression, and can be thought of as the last decompression stop of a dive. It can take up to 24 hours for the body to return to its normal atmospheric levels of inert gas saturation after a dive.
Decompression theory
Decompression theory is the study and modelling of the transfer of the inert gas component of breathing gases from the gas in the lungs to the tissues of the diver and back during exposure to variations in ambient pressure. In the case of underwater diving and compressed air work, this mostly involves ambient pressures greater than the local surface pressure—but astronauts, high altitude mountaineers, and occupants of unpressurised aircraft, are exposed to ambient pressures less than standard sea level atmospheric pressure. In all cases, the symptoms of decompression sickness occur during or within a relatively short period of hours, or occasionally days, after a significant reduction of ambient pressure.
Physics and physiology of decompression
The absolute pressure on an ambient pressure diver is the sum of the local atmospheric pressure and hydrostatic pressure. Hydrostatic pressure is the component of ambient pressure due to the weight of the water column above the depth, and is commonly described in terms of metres or feet of sea water.
The ambient pressure of the water is transmitted to the diver by direct contact with the skin and indirect contact through the divers suit and soft equipment. The soft tissues are incompressible and the pressure is transferred through them to any gas spaces. Since gases are compressible they will be compressed until the pressure is balanced. In the case of a breath-hold diver the lungs and upper airways must reduce in volume to compress their gaseous contents to balance the pressure in the walls of the gas spaces. If the spaces are not sufficiently compliant, fluids will accumulate in the adjacent tissues, which may be damaged, resulting in oedema and possibly internal haemorrhage. When the diver has an ambient pressure breathing gas supply, ambient pressure gas can flow in to fill the gas space without a forced volume reduction. This inflow of ambient pressure gas is known as pressure equalisation. A similar effect occurs in external gas spaces in contact with the skin or isolated from the body.
The absorption of gases in liquids depends on the solubility of the specific gas in the specific liquid, the concentration of gas, customarily expressed as partial pressure, and temperature. The main variable in the study of decompression theory is pressure.
Once dissolved, distribution of the dissolved gas may be by diffusion, where there is no bulk flow of the solvent, or by perfusion where the solvent (in this case blood) is circulated around the diver's body, where gas can diffuse to local regions of lower concentration. Given sufficient time at a specific partial pressure in the breathing gas, the concentration in the tissues stabilises, or saturates, at a rate that depends on solubility, diffusion rate and perfusion, all of which vary in the different tissues of the body. This process is referred to as in-gassing, and is usually modelled as an inverse exponential process.
If the concentration of the inert gas in the breathing gas is reduced below that of any of the tissues, there is a tendency for gas to return from the tissues to the breathing gas. This is known as out-gassing, and occurs during decompression, when the reduction in ambient pressure reduces the partial pressure of the inert gas in the lungs. This process may be complicated by the formation of gas bubbles, as the modelling of bubbles is more complex and varied.
The combined concentrations of gases in any given tissue depend on the history of pressure and gas composition. Under equilibrium conditions, the total concentration of dissolved gases is less than the ambient pressure—as oxygen is metabolised in the tissues, and the carbon dioxide produced is much more soluble. However, during a reduction in ambient pressure, the rate of pressure reduction may exceed the rate at which gas is eliminated by diffusion and perfusion. If the concentration gets too high, it may reach a stage where bubble formation can occur in the supersaturated tissues. When the pressure of gases in a bubble exceed the combined external pressures of ambient pressure and the surface tension of the bubble-liquid interface, the bubbles grow, and this growth can damage tissue.
If the dissolved inert gases come out of solution within the tissues of the body and form bubbles, they may cause the condition known as decompression sickness, or DCS, also known as divers' disease, the bends or caisson disease. However, not all bubbles result in symptoms, and Doppler bubble detection shows that venous bubbles are present in a significant number of asymptomatic divers after relatively mild hyperbaric exposures.
Since bubbles can form in or migrate to any part of the body, DCS can produce many symptoms, and its effects may vary from joint pain and rashes to paralysis and death. Individual susceptibility can vary from day to day, and different individuals under the same conditions may be affected differently or not at all. The classification of types of DCS by its symptoms has evolved since its original description.
Efficient decompression requires the diver to ascend fast enough to establish as high a decompression gradient, in as many tissues, as safely possible, without provoking the development of symptomatic bubbles. This is facilitated by the highest acceptably safe oxygen partial pressure in the breathing gas, and avoiding gas changes that could cause inert gas counterdiffusion bubble formation or growth. The development of schedules that are both safe and efficient has been complicated by the large number of variables and uncertainties, including personal variation in response under varying environmental conditions and workload.
The risk of decompression sickness after diving can be managed through effective decompression procedures and contracting it is now uncommon, though it remains to some degree unpredictable. Its potential severity has driven much research to prevent it and divers almost universally use decompression tables or dive computers to limit or monitor their exposure and to control their ascent rate and decompression procedures. If DCS is contracted, it is usually treated by hyperbaric oxygen therapy in a recompression chamber. If treated early, there is a significantly higher chance of successful recovery.
A diver who only breathes gas at atmospheric pressure when free-diving or snorkelling will not usually need to decompress but it is possible to get a form of decompression sickness, called taravana, from repetitive deep free-diving with short surface intervals.
Decompression models
Actual rates of diffusion and perfusion, and solubility of gases in specific physiological tissues are not generally known, and vary considerably. However mathematical models have been proposed that approximate the real situation to a greater or lesser extent. These models predict whether symptomatic bubble formation is likely to occur for a given dive profile. Algorithms based on these models produce decompression tables. In personal dive computers, they produce a real-time estimate of decompression status and display a recommended ascent profile for the diver, which may include decompression stops.