{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:59:17Z","timestamp":1785823157344,"version":"3.56.0"},"reference-count":17,"publisher":"Diving and Hyperbaric Medicine Journal","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diving Hyperb Med"],"abstract":"<jats:p>Introduction: Venous gas emboli (VGE) are a common surrogate experimental endpoint for decompression sickness (DCS). VGE numbers are graded, and the peak post-dive grade is associated with the probability of DCS (PDCS). VGE are typically graded with the subject at rest when bubble numbers are stable, and again after limb flexions which elicit a transient shower of bubbles. Detection of VGE using two-dimensional (2-D) echocardiography has become common, but the principal grading scales do not specify how to grade VGE after limb movement.\nMethods: This was a retrospective analysis of 1,196 man-dives following which VGE were detected using 2-D echocardiography and graded on a scale 0\u20134 and 41 cases of DCS occurred. PDCS was estimated for each peak post-dive VGE grade from the cumulative incidence of DCS. Two different definitions of movement VGE grades were assessed in 84 measurements; the grade was either the maximum VGE number sustained for one diastole (1-cycle) or for six cardiac cycles (6-cycle).\nResults: For each peak post-dive VGE grade (maximum of rest or movement) the cumulative incidences of DCS (%) were: grade 0 (0%); grade 1 (1.3%); grade 2 (2.5%); grade 3 (4.6%); grade 4 (5.7%). When grading movement VGE, 57% of 1-cycle grade 4 were reduced to grade 3 using the 6-cycle definition.\nConclusions: There is a need for consensus in the research community on how to assign movement VGE grades when using 2-D echocardiography. Publications should carefully explain methodology for assigning VGE grades and consider differences in methodologies when comparing historical data sets.<\/jats:p>","DOI":"10.28920\/dhm55.1.44-50","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T22:57:16Z","timestamp":1742252236000},"page":"44-50","source":"Crossref","is-referenced-by-count":2,"title":["Venous gas emboli (VGE) in 2-D echocardiographic images following movement: grading and association with cumulative incidence of decompression sickness"],"prefix":"10.28920","volume":"55","author":[{"name":"Navy Experimental Diving Unit, Panama City, Florida, USA","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua B","family":"Currens","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Radiology and Joint Department of Biomedical Engineering, University of North Carolina \u2013 Chapel Hill, NC, USA","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Doolette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Navy Experimental Diving Unit, Panama City, Florida, USA","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Department of Anaesthesiology, University of Auckland, Auckland, New Zealand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F Gregory","family":"Murphy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Navy Experimental Diving Unit, Panama City, Florida, USA","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11463","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"ref0","unstructured":"1 Doolette DJ. Venous gas emboli detected by two-dimensional echocardiography are an imperfect surrogate for decompression sickness. Diving Hyperb Med. 2016;46:4-10. PMID: 27044455. [cited 2024 Oct 1]. Available from: https:\/\/dhmjournal.com\/images\/IndividArticles\/46March\/Doolette_dhm.46.1.4-10.pdf."},{"key":"ref1","unstructured":"2 Doolette DJ, Gault KA, Gutvik CR. Sample size requirement for comparison of decompression outcomes using ultrasonically detected venous gas emboli (VGE): power calculations using Monte Carlo resampling from real data. Diving Hyperb Med. 2014;44:14-9. PMID: 24687480. [cited 2024 Oct 1]. Available from: https:\/\/dhmjournal.com\/images\/IndividArticles\/44March\/Doolette_dhm.44.1.14-19.pdf."},{"key":"ref2","unstructured":"3 Eftedal OS, Tjelmeland H, Brubakk AO. Validation of decompression procedures based on detection of venous gas bubbles: a Bayesian approach. Aviat Space Environ Med. 2007;78:94-9. PMID: 17310879."},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"4 Hjelte C, Plogmark O, Silvanius M, Ekstr\u00f6m M, Fr\u00e5nberg O. Risk assessment of SWEN21 a suggested new dive table for the Swedish armed forces: bubble grades by ultrasonography. Diving Hyperb Med. 2023;53:299-305. doi: 10.28920\/dhm53.4.299-305. PMID: 38091588. PMCID: PMC10944666.","DOI":"10.28920\/dhm53.4.299-305"},{"key":"ref4","unstructured":"5 Sawatzky KD. The relationship between intravascular Doppler-detected gas bubbles and decompression sickness after bounce diving in humans [master's thesis]. Toronto (Canada): York University; 1991."},{"key":"ref5","unstructured":"6 Nishi RY, Brubakk AO, Eftedal OS. Bubble detection. In: Brubakk AO, Neuman TS, editors. Bennett and Elliott's physiology and medicine of diving. 5th ed. Edinburgh: Saunders; 2003. p. 501-29."},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"7 Le DQ, Dayton PA, Tillmans F, Freiberger JJ, Moon RE, Denoble P, et al. Ultrasound in decompression research: fundamentals, considerations, and future technologies. Undersea Hyperb Med. 2021;48:59-72. PMID: 33648035.","DOI":"10.22462\/01.03.2021.8"},{"key":"ref7","unstructured":"8 M\u00f8llerl\u00f8kken A, Blogg SL, Doolette DJ, Nishi RY, Pollock NW. Consensus guidelines for the use of ultrasound for diving research. Diving Hyperb Med. 2016;46:26-32. PMID: 27044459. [cited 2024 Oct 1]. Available from: https:\/\/dhmjournal.com\/images\/IndividArticles\/46March\/Mollerlokken_dhm.46.1.26-32.pdf."},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"9 Doolette DJ, Murphy FG. Within-diver variability in venous gas emboli (VGE) following repeated dives. Diving Hyperb Med. 2023;53:333-9. doi: 10.28920\/dhm53.4.333-339. PMID: 38091593. PMCID: PMC10944664.","DOI":"10.28920\/dhm53.4.333-339"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"10 Thom SR, Milovanova TN, Bogush M, Bhopale VM, Yang M, Bushmann K, et al. Microparticle production, neutrophil activation, and intravascular bubbles following open-water SCUBA diving. J Appl Physiol (1985). 2012;112:1268-78. PMID: 22323646.","DOI":"10.1152\/japplphysiol.01305.2011"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"11 Thom SR, Milovanova TN, Bogush M, Yang M, Bhopale VM, Pollock NW, et al. Bubbles, microparticles, and neutrophil activation: changes with exercise level and breathing gas during open-water SCUBA diving. J Appl Physiol (1985). 2013;114:1396-405. PMID: 23493363.","DOI":"10.1152\/japplphysiol.00106.2013"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"12 Gerth WA, Ruterbusch VL, Long ET. The influence of thermal exposure on diver susceptibility to decompression sickness. Technical Report NEDU TR 06-07. Panama City (FL): Navy Experimental Diving Unit; 2007. [cited 2024 Oct 1]. Available from: https:\/\/apps.dtic.mil\/sti\/pdfs\/ADA480570.pdf.","DOI":"10.21236\/ADA480118"},{"key":"ref12","unstructured":"13 Doolette DJ, Gerth WA, Gault KA. Redistribution of decompression stop time from shallow to deep stops increases incidence of decompression sickness in air decompression dives. Technical Report NEDU TR 11-06. Panama City (FL): Navy Experimental Diving Unit; 2011. [cited 2024 Oct 1]. Available from: https:\/\/apps.dtic.mil\/sti\/pdfs\/ADA561618.pdf."},{"key":"ref13","unstructured":"14 Doolette DJ, Gault KA, Gerth WA. Manipulating the duration and frequency of air breaks during oxygen-decompression did not identify a direct contribution of oxygen to decompression stress. Technical Report NEDU TR 17-13. Panama City (FL): Navy Experimental Diving Unit; 2013. Available from: https:\/\/apps.dtic.mil\/sti\/trecms\/pdf\/AD1215266.pdf."},{"key":"ref14","unstructured":"15 Andrew BT, Doolette DJ. Manned validation of the U.S. Navy diving manual, revision 7 schedules for short bottom time, deep air decompression dives (VVal-79 Thalmann Algorithm). Technical Report NEDU TR 19-06. Panama City (FL): Navy Experimental Diving Unit; 2019. [cited 2024 Oct 1]. Available from: https:\/\/apps.dtic.mil\/sti\/trecms\/pdf\/AD1215269.pdf."},{"key":"ref15","unstructured":"16 Eftedal O, Brubakk AO. Agreement between trained and untrained observers in grading intravascular bubble signals in ultrasonic images. Undersea Hyperb Med. 1997;24:293-9. PMID: 9444060."},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"17 Ljubkovic M, Dujic Z, M\u00f8llerl\u00f8kken A, Bakovic D, Obad A, Breskovic T, et al. Venous and arterial bubbles at rest after no-decompression air dives. Med Sci Sports Exerc. 2011;43:990-5. PMID: 21085032.","DOI":"10.1249\/MSS.0b013e31820618d3"}],"container-title":["Diving and Hyperbaric Medicine Journal"],"original-title":[],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T00:42:08Z","timestamp":1749602528000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.dhmjournal.com\/index.php\/journals?view=article&id=352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,31]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,3,31]]}},"URL":"https:\/\/doi.org\/10.28920\/dhm55.1.44-50","relation":{},"ISSN":["2209-1491"],"issn-type":[{"value":"2209-1491","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,31]]}}}