Water covers over 70% of the earth, has varying depths and temperatures and contains much of the earth's resources. Head-out water immersion (HOWI) or submersion at various depths (diving) in water of thermoneutral (TN) temperature elicits profound cardiorespiratory, endocrine, and renal responses. The translocation of blood into the thorax and elevation of plasma volume by autotransfusion of fluid from cells to the vascular compartment lead to increased cardiac stroke volume and output and there is a hyperperfusion of some tissues. Pulmonary artery and capillary hydrostatic pressures increase causing a decline in vital capacity with the potential for pulmonary edema. Atrial stretch and increased arterial pressure cause reflex autonomic responses which result in endocrine changes that return plasma volume and arterial pressure to preimmersion levels. Plasma volume is regulated via a reflex diuresis and natriuresis. Hydrostatic pressure also leads to elastic loading of the chest, increasing work of breathing, energy cost, and thus blood flow to respiratory muscles. Decreases in water temperature in HOWI do not affect the cardiac output compared to TN; however, they influence heart rate and the distribution of muscle and fat blood flow. The reduced muscle blood flow results in a reduced maximal oxygen consumption. The properties of water determine the mechanical load and the physiological responses during exercise in water (e.g. swimming and water based activities). Increased hydrostatic pressure caused by submersion does not affect stroke volume; however, progressive bradycardia decreases cardiac output. During submersion, compressed gas must be breathed which introduces the potential for oxygen toxicity, narcosis due to nitrogen, and tissue and vascular gas bubbles during decompression and after may cause pain in joints and the nervous system.

Human Physiology in an Aquatic Environment.

The following topics are reviewed in relation to diving: the physical properties of hyperbaric gases; light and vision; sound, hearing and speech; the cardiovascular system; the lungs; thermal regulation; decompression sickness; central nervous system.

https://iopscience.iop.org/article/10.1088/0143-0815/8/3/001/pdf

Physics and physiology in the hyperbaric environment

The partial pressure of end tidal carbon dioxide (PETCO 2), ventilatory sensitivity to CO 2, and cerebral perfusion are augmented during thermoneutral head out water immersion (HOWI). We tested the hypotheses that HOWI and acute hypercapnia augments minute ventilation, ventilatory sensitivity to CO 2, cerebral perfusion, and cerebrovascular reactivity to CO 2. Twelve subjects (age: 24 ± 3 years, BMI: 25.3 ± 2.9 kg/m2, 6 women) participated in two experimental visits: a HOWI visit (HOWI) and a matched hypercapnia visit (Dry + CO 2). A rebreathing test was conducted at baseline, 10, 30, 60 min, and post HOWI and Dry + CO 2. PETCO 2, minute ventilation, expired gases, blood pressure, heart rate, and middle cerebral artery blood velocity were recorded continuously. PETCO 2 increased throughout HOWI (baseline: 42 ± 2 mmHg; maximum at 10 min: 44 ± 2 mmHg, P ≤ 0.013) and Dry + CO 2 (baseline: 42 ± 2 mmHg; maximum at 10 min: 44 ± 2 mmHg, P ≤ 0.013) and was matched between conditions (condition main effect: P = 0.494). Minute ventilation was lower during HOWI versus Dry + CO 2 (maximum difference at 60 min: 13.2 ± 1.9 vs. 16.2 ± 2.7 L/min, P < 0.001). Ventilatory sensitivity to CO 2 and middle cerebral artery blood velocity were greater during HOWI versus Dry + CO 2 (maximum difference at 10 min: 2.60 ± 1.09 vs. 2.20 ± 1.05 L/min/mmHg, P < 0.001, and 63 ± 18 vs. 53 ± 14 cm/sec, P < 0.001 respectively). Cerebrovascular reactivity to CO 2 decreased throughout HOWI and Dry + CO 2 and was not different between conditions (condition main effect: P = 0.777). These data indicate that acute hypercapnia, matched to what occurs during HOWI, augments minute ventilation but not ventilatory sensitivity to CO 2 or middle cerebral artery blood velocity despite an attenuated cerebrovascular reactivity to CO 2.

https://physoc.onlinelibrary.wiley.com/doi/pdf/10.14814/phy2.13901

The effect of water immersion and acute hypercapnia on ventilatory sensitivity and cerebrovascular reactivity.

Divers can experience cognitive impairment due to inert gas narcosis (IGN) at depth. Brain-derived neurotrophic factor (BDNF) rules neuronal connectivity/metabolism to maintain cognitive function and protect tissues against oxidative stress (OxS). Dopamine and glutamate enhance BDNF bioavailability. Thus, we hypothesized that lower circulating BDNF levels (via lessened dopamine and/or glutamate release) underpin IGN in divers, while testing if BDNF loss is associated with increased OxS.To mimic IGN, we administered a deep narcosis test via a dry dive test (DDT) at 48 msw in a multiplace hyperbaric chamber to six well-trained divers. We collected: (1) saliva samples before DDT (T0), 25 msw (descending, T1), 48 msw (depth, T2), 25 msw (ascending, T3), 10 min after decompression (T4) to dopamine and/or reactive oxygen species (ROS) levels; (2) blood and urine samples at T0 and T4 for OxS too. We administered cognitive tests at T0, T2, and re-evaluated the divers at T4.At 48 msw, all subjects experienced IGN, as revealed by the cognitive test failure. Dopamine and total antioxidant capacity (TAC) reached a nadir at T2 when ROS emission was maximal. At decompression (T4), a marked drop of BDNF/glutamate content was evidenced, coinciding with a persisting decline in dopamine and cognitive capacity.Divers encounter IGN at - 48 msw, exhibiting a marked loss in circulating dopamine levels, likely accounting for BDNF-dependent impairment of mental capacity and heightened OxS. The decline in dopamine and BDNF appears to persist at decompression; thus, boosting dopamine/BDNF signaling via pharmacological or other intervention types might attenuate IGN in deep dives. 

/pdf/dopamine-bdnf-loss-underscores-narcosis-cognitive-impairment-3913iz8o.pdf

Dopamine/BDNF loss underscores narcosis cognitive impairment in divers: a proof of concept in a dry condition

Deep diving refers to saturation diving to a depth of more than 180 m (1.9 MPa ambient pressure). In the 1990s diving to 400 m may be necessary on the Norwegian continental shelf. The safety margins are narrow and at such depths the respiratory system is subject to great strain. Respiratory resistance increases and the dynamic lung volumes are reduced as the pressure increases due to enhanced gas density. Helium is used together with oxygen as breathing gas and the lower density partly normalises the dynamic lung volumes. The respiratory system imposes clear limitations on the intensity and duration of physical work during deep diving. We lack systematic studies of lung mechanics, gas exchange and respiratory regulation in the different phases of deep dives. Demonstration of possible chronic occupational respiratory diseases connected to diving is dependent on follow-up over a long time.

Respiratory changes in deep diving

The ventilation (V), end-tidal PCO2 (PACO2), and CO2 elimination rate were determined in men at rest breathing CO2-free gas over the pressure range 1-50 ATA and the gas density range 0.4-25 g/l, during slow and rapid compressions, at stable elevated ambient pressures and during slow decompressions. Progressive increase in pulmonary gas flow resistance due to elevation of ambient pressure and inspired gas density to the He-O2 equivalent of 5000 feet of seawater was found to produce a complex pattern of change in PACO2. It was found that as both ambient pressure and pulmonary gas flow resistance were progressively raised, PACO2 at first increased, went through a maximum, and then declined towards values near the 1 ATA level. It is concluded that this pattern of PACO2 change results from the interaction on ventilation of the increase in pulmonary resistance due to the elevation of gas density with the increase in respiratory drive postulated as due to generalized central nervous system excitation associated with exposure to high hydrostatic pressure. It is suggested that a similar interaction exists between increased gas flow resistance and the increase in respiratory drive related to nitrogen partial pressure and the resulting narcosis.

Human respiration at rest in rapid compression and at high pressures and gas densities.

Human tolerance to He, Ne, and N2 at respiratory gas densities equivalent to He-O2 breathing at depths to 1200, 2000, 3000, 4000, and 5000 feet of sea water (predictive studies III).

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Human respiration at rest in rapid compression and at high pressures and gas densities.

Human tolerance to He, Ne, and N2 at respiratory gas densities equivalent to He-O2 breathing at depths to 1200, 2000, 3000, 4000, and 5000 feet of sea water (predictive studies III).