Risk assessment of SWEN21 a suggested new dive table for the Swedish armed forces: bubble grades by ultrasonography

Introduction: To develop the diving capacity in the Swedish armed forces the current air decompression tables are under revision. A new decompression table named SWEN21 has been created to have a projected risk level of 1% for decompression sickness (DCS) at the no stop limits. The aim of this study was to evaluate the safety of SWEN21 through the measurement of venous gas emboli (VGE) in a dive series. Methods: A total 154 dives were conducted by 47 divers in a hyperbaric wet chamber. As a proxy for DCS risk serial VGE measurements by echocardiography were conducted and graded according to the Eftedal-Brubakk scale. Measurements were done every 15 minutes for approximately 2 hours after each dive. Peak VGE grades for the different dive profiles were used in a Bayesian approach correlating VGE grade and risk of DCS. Symptoms of DCS were continually monitored. Results: The median (interquartile range) peak VGE grade after limb flexion for a majority of the time-depth combinations, and of SWEN21 as a whole, was 3 (3–4) with the exception of two decompression profiles which resulted in a grade of 3.5 (3–4) and 4 (4–4) respectively. The estimated risk of DCS in the Bayesian model varied between 4.7–11.1%. Three dives (2%) resulted in DCS. All symptoms resolved with hyperbaric oxygen treatment. Conclusions: This evaluation of the SWEN21 decompression table, using bubble formation measured with echocardiography, suggests that the risk of DCS may be higher than the projected 1%.