Oxygen toxicity

Toxic effects of breathing oxygen at high partial pressures

Medical condition

Oxygen toxicity

Other names| Oxygen toxicity syndrome, oxygen intoxication, oxygen poisoning
In 1942–43 the UK Government carried out extensive testing for oxygen toxicity in divers. The chamber is pressurised with air to 3.7 bar. The subject in the centre is breathing 100% oxygen from a mask.[1]
Specialty| Diving medicine, hyperbaric medicine, neonatal medicine.

Oxygen toxicity is a condition resulting from the harmful effects of breathing molecular oxygen (O
2) at increased partial pressures. Severe cases can result in cell damage and death, with effects most often seen in the central nervous system, lungs, and eyes. Historically, the central nervous system condition was called the Paul Bert effect, and the pulmonary condition the Lorrain Smith effect, after the researchers who pioneered the discoveries and descriptions in the late 19th century. Oxygen toxicity is a concern for underwater divers, those on high concentrations of supplemental oxygen, and those undergoing hyperbaric oxygen therapy.

The result of breathing increased partial pressures of oxygen is hyperoxia, an excess of oxygen in body tissues. The body is affected in different ways depending on the type of exposure. Central nervous system toxicity is caused by short exposure to high partial pressures of oxygen at greater than atmospheric pressure. Pulmonary and ocular toxicity result from longer exposure to increased oxygen levels at normal pressure. Symptoms may include disorientation, breathing problems, and vision changes such as myopia. Prolonged exposure to above-normal oxygen partial pressures, or shorter exposures to very high partial pressures, can cause oxidative damage to cell membranes, collapse of the alveoli in the lungs, retinal detachment, and seizures. Oxygen toxicity is managed by reducing the exposure to increased oxygen levels. Studies show that, in the long term, a robust recovery from most types of oxygen toxicity is possible.

Protocols for avoidance of the effects of hyperoxia exist in fields where oxygen is breathed at higher-than-normal partial pressures, including underwater diving using compressed breathing gases, hyperbaric medicine, neonatal care and human spaceflight. These protocols have resulted in the increasing rarity of seizures due to oxygen toxicity, with pulmonary and ocular damage being largely confined to the problems of managing premature infants.

In recent years, oxygen has become available for recreational use in oxygen bars. The US Food and Drug Administration has warned those who have conditions such as heart or lung disease not to use oxygen bars. Scuba divers use breathing gases containing up to 100% oxygen, and should have specific training in using such gases.

## Classification

[edit]

Breathing air with high oxygen pressure can lead to several adverse effects.

The effects of oxygen toxicity may be classified by the organs affected, producing three principal forms:[2][3][4]

* Central nervous system, characterised by convulsions followed by unconsciousness, occurring under hyperbaric conditions;
* Pulmonary (lungs), characterised by difficulty in breathing and pain within the chest, occurring when breathing increased pressures of oxygen for extended periods;
* Ocular (retinopathic conditions), characterised by alterations to the eyes, occurring when breathing increased pressures of oxygen for extended periods.

Central nervous system oxygen toxicity can cause seizures, brief periods of rigidity followed by convulsions and unconsciousness, and is of concern to divers who encounter greater than atmospheric pressures. Pulmonary oxygen toxicity results in damage to the lungs, causing pain and difficulty in breathing.[2] Oxidative damage to the eye may lead to myopia or partial detachment of the retina. Pulmonary and ocular damage are most likely to occur when supplemental oxygen is administered as part of a treatment, particularly to newborn infants, but are also a concern during hyperbaric oxygen therapy.[5][6]

Oxidative damage may occur in any cell in the body but the effects on the three most susceptible organs will be the primary concern. It may also be implicated in damage to red blood cells (haemolysis),[7][8] the liver,[9] heart,[10] endocrine glands (adrenal glands, gonads, and thyroid),[11][12][13] or kidneys,[14] and general damage to cells.[2][15]

In unusual circumstances, effects on other tissues may be observed: it is suspected that during spaceflight, high oxygen concentrations may contribute to bone damage.[16] Hyperoxia can also indirectly cause carbon dioxide narcosis in patients with lung ailments such as chronic obstructive pulmonary disease or with central respiratory depression.[16] Hyperventilation of atmospheric air at atmospheric pressures does not cause oxygen toxicity, because sea-level air has a partial pressure of oxygen of 0.21 bar (21 kPa) whereas toxicity does not occur below 0.3 bar (30 kPa).[17]

## Signs and symptoms

[edit]

Oxygen poisoning at 90 feet (27 m) in the dry in 36 subjects in order of performance[1] Exposure (mins.)  | Num. of subjects  | Symptoms

|
|

96  | 1  | Prolonged dazzle; severe spasmodic vomiting
60–69  | 3  | Severe lip-twitching; euphoria; nausea and vertigo; arm twitch
50–55  | 4  | Severe lip-twitching; dazzle; blubbering of lips; fell asleep; dazed
31–35  | 4  | Nausea, vertigo, lip-twitching; convulsed
21–30  | 6  | Convulsed; drowsiness; severe lip-twitching; epigastric aura; twitch L arm; amnesia
16–20  | 8  | Convulsed; vertigo and severe lip twitching; epigastric aura; spasmodic respiration;
11–15  | 4  | Inspiratory predominance; lip-twitching and syncope; nausea and confusion
6–10  | 6  | Dazed and lip-twitching; paraesthesiae; vertigo; "Diaphragmatic spasm"; severe nausea

### Central nervous system

[edit]

Central nervous system oxygen toxicity manifests as symptoms such as visual changes (especially tunnel vision), ringing in the ears (tinnitus), nausea, twitching (especially of the face), behavioural changes (irritability, anxiety, confusion), and dizziness. This may be followed by a tonic–clonic seizure consisting of two phases: intense muscle contraction occurs for several seconds (tonic phase); followed by rapid spasms of alternate muscle relaxation and contraction producing convulsive jerking (clonic phase). The seizure ends with a period of unconsciousness (the postictal state).[18][19] The onset of seizure depends upon the partial pressure of oxygen in the breathing gas and exposure duration. However, exposure time before onset is unpredictable, as tests have shown a wide variation, both amongst individuals, and in the same individual from day to day.[18][20][21] In addition, many external factors, such as underwater immersion, exposure to cold, and exercise will decrease the time to onset of central nervous system symptoms.[1] Decrease of tolerance is closely linked to retention of carbon dioxide.[22][23][24] Other factors, such as darkness and caffeine, increase tolerance in test animals, but these effects have not been proven in humans.[25][26]

### Lungs

[edit]

Exposure to oxygen pressures greater than 0.5 bar, such as during diving, oxygen prebreathing prior to flight, or hyperbaric therapy is associated with the onset of pulmonary toxicity symptoms,[27] also referred to as chronic oxygen toxicity.[28] Pulmonary toxicity symptoms result from an inflammation that starts in the airways leading to the lungs and then spreads into the lungs (tracheobronchial tree). The symptoms appear in the upper chest region (substernal and carinal regions).[29][30][31] This begins as a mild tickle on inhalation and progresses to frequent coughing.[29] If breathing increased partial pressures of oxygen continues, subjects experience a mild burning on inhalation along with uncontrollable coughing and occasional shortness of breath (dyspnea).[29] Physical findings related to pulmonary toxicity have included bubbling sounds heard through a stethoscope (bubbling rales), fever, and increased blood flow to the lining of the nose (hyperaemia of the nasal mucosa).[31] Initially, there is an exudative phase that results in Pulmonary edema. An increase in the width of the interstitial space may be seen in histological examination.[27] X-rays of the lungs show little change in the short term, but extended exposure leads to increasing diffuse shadowing throughout both lungs.[29] Pulmonary function measurements are reduced, as indicated by a reduction in the amount of air that the lungs can hold (vital capacity) and changes in expiratory function and lung elasticity.[31][32] Lung diffusing capacity decreases leading eventually to hypoxaemia.[27] Tests in animals have indicated a variation in tolerance similar to that found in central nervous system toxicity, as well as significant variations between species. When the exposure to oxygen above 0.5 bar (50 kPa) is intermittent, it permits the lungs to recover and delays the onset of toxicity.[33] A similar progression is common to all mammalian species.[27] If death from hypoxaemia has not occurred after exposure for several days a proliferative phase occurs, developing a chronic thickening of the alveolar membrane and a decrement in lung diffusing capacity. These changes are mostly reversible on return to normoxia, but the time required for complete recovery is not known.[27]

### Eyes

[edit]

In premature babies, signs of damage to the eye (retinopathy of prematurity, or ROP) are observed via an ophthalmoscope as a demarcation between the vascularised and non-vascularised regions of an infant's retina. The degree of this demarcation is used to designate four stages: (I) the demarcation is a line; (II) the demarcation becomes a ridge; (III) growth of new blood vessels occurs around the ridge; (IV) the retina begins to detach from the inner wall of the eye (choroid).[5]

## Causes

[edit]

Oxygen toxicity is caused by hyperoxia, exposure to oxygen at partial pressures greater than those to which the body is normally exposed. This occurs in three principal settings: underwater diving,[34] hyperbaric oxygen therapy,[35] and the provision of supplemental oxygen, in critical care,[36] and for long-term treatment of chronic disorders, and particularly to premature infants.[37] In each case, the risk factors are markedly different.[34][35][37]

Under normal or reduced ambient pressures, the effects of hyperoxia are initially restricted to the lungs, which are directly exposed, but after prolonged exposure or at hyperbaric pressures, other organs can be at risk. At normal partial pressures of inhaled oxygen, most of the oxygen transported in the blood is carried by haemoglobin, but the amount of dissolved oxygen will increase at partial pressures of arterial oxygen exceeding 100 millimetres of mercury (0.13 bar), when oxyhemoglobin saturation is nearly complete. At higher concentrations the effects of hyperoxia are more widespread in the body tissues beyond the lungs.[38]

### Central nervous system toxicity

[edit]

See also: Technical diving

Exposures, from minutes to a few hours, to partial pressures of oxygen above about 1.6 bars (160 kPa)—about eight times normal atmospheric partial pressure—are usually associated with central nervous system oxygen toxicity, also known as acute oxygen toxicity,[28] and are most likely to occur among patients undergoing hyperbaric oxygen therapy and divers. Since sea level atmospheric pressure is about 1 bar (100 kPa), central nervous system toxicity can only occur under hyperbaric conditions, where ambient pressure is above normal.[35][39] Divers breathing air at depths beyond 60 m (200 ft) face an increasing risk of an oxygen toxicity "hit" (seizure). Divers breathing a gas mixture enriched with oxygen, such as nitrox, similarly increase the risk of a seizure at shallower depths, should they descend below the maximum operating depth accepted for the mixture.[40] CNS toxicity is aggravated by a high partial pressure of carbon dioxide, stress, fatigue, and cold, all of which are much more likely in diving than in hyperbaric therapy.[28]

### Lung toxicity

[edit]

The curves show typical decrement in lung vital capacity when breathing oxygen. Lambertsen concluded in 1987 that 0.5 bar (50 kPa) could be tolerated indefinitely.

The lungs and the remainder of the respiratory tract are exposed to the highest concentration of oxygen in the human body and are therefore the first organs to show chronic toxicity.[28] Pulmonary toxicity occurs only with exposure to partial pressures of oxygen greater than 0.5 bar (50 kPa), corresponding to an oxygen fraction of 50% at normal atmospheric pressure. The earliest signs of pulmonary toxicity begin with evidence of tracheobronchitis, or inflammation of the upper airways, after an asymptomatic period between 4 and 22 hours at greater than 95% oxygen,[41] with some studies suggesting symptoms usually begin after approximately 14 hours at this level of oxygen.[42]

At partial pressures of oxygen of 2 to 3 bar (200 to 300 kPa)—100% oxygen at 2 to 3 times atmospheric pressure—these symptoms may begin as early as 3 hours into exposure to oxygen.[41] Experiments on rats breathing oxygen at pressures between 1 and 3 bars (100 and 300 kPa) suggest that pulmonary manifestations of oxygen toxicity may not be the same for normobaric conditions as they are for hyperbaric conditions.[43] Evidence of decline in lung function as measured by pulmonary function testing can occur as quickly as 24 hours of continuous exposure to 100% oxygen,[42] with evidence of diffuse alveolar damage and the onset of acute respiratory distress syndrome usually occurring after 48 hours on 100% oxygen.[41] Breathing 100% oxygen also eventually leads to collapse of the alveoli (atelectasis), while—at the same partial pressure of oxygen—the presence of significant partial pressures of inert gases, typically nitrogen, will prevent this effect.[44]

Preterm newborns are known to be at higher risk for bronchopulmonary dysplasia with extended exposure to high concentrations of oxygen.[45] Other groups at higher risk for oxygen toxicity are patients on mechanical ventilation with exposure to levels of oxygen greater than 50%, and patients exposed to chemicals that increase risk for oxygen toxicity such the chemotherapeutic agent bleomycin.[42] Therefore, current guidelines for patients on mechanical ventilation in intensive care recommend keeping oxygen concentration less than 60%.[41] Likewise, divers who undergo treatment of decompression sickness are at increased risk of oxygen toxicity as treatment entails exposure to long periods of oxygen breathing under hyperbaric conditions, in addition to any oxygen exposure during the dive.[35]

### Ocular toxicity

[edit]

See also: Retinopathy of prematurity

Prolonged exposure to high inspired fractions of oxygen causes damage to the retina.[46][47][48] Damage to the developing eye of infants exposed to high oxygen fraction at normal pressure has a different mechanism and effect from the eye damage experienced by adult divers under hyperbaric conditions.[49][50] Hyperoxia may be a contributing factor for the disorder called retrolental fibroplasia or retinopathy of prematurity (ROP) in infants.[49][51] In preterm infants, the retina is often not fully vascularised. Retinopathy of prematurity occurs when the development of the retinal vasculature is arrested and then proceeds abnormally. Associated with the growth of these new vessels is fibrous tissue (scar tissue) that may contract to cause retinal detachment. Supplemental oxygen exposure, while a risk factor, is not the main risk factor for development of this disease. Restricting supplemental oxygen use does not necessarily reduce the rate of retinopathy of prematurity, and may raise the risk of hypoxia-related systemic complications.[49]

Hyperoxic myopia has occurred in closed circuit oxygen rebreather divers with prolonged exposures.[50][52][53] It also occurs frequently in those undergoing repeated hyperbaric oxygen therapy.[47][54] This is due to an increase in the refractive power of the lens, since axial length and keratometry readings do not reveal a corneal or length basis for a myopic shift.[54][55] It is usually reversible with time.[47][54]

A possible side effect of hyperbaric oxygen therapy is the initial or further development of cataracts, which are an increase in opacity of the lens of the eye which reduces visual acuity, and can eventually result in blindness. This is a rare event, associated with lifetime exposure to raised oxygen concentration, and may be under-reported as it develops very slowly, and cataracts are a common disorder of advanced age. The cause is not fully understood, but evidence suggests that raised oxygen levels at the lens may be caused by deterioration of the vitreous humour due to age, and this causes degradation of lens crystallins by cross-linking, forming aggregates capable of scattering light. This may be an end-state development of the more commonly observed myopic shift associated with hyperbaric treatment.[6]

## Mechanism

[edit]

Main articles: Reactive oxygen species and Oxidative stress

The lipid peroxidation mechanism shows a single radical initiating a chain reaction which converts unsaturated lipids to lipid peroxides.

The biochemical basis for the toxicity of oxygen is the partial reduction of oxygen by one or two electrons to form reactive oxygen species,[56] which are natural by-products of the normal metabolism of oxygen and have important roles in cell signalling.[57] One species produced by the body, the superoxide anion (O−
2),[58] is possibly involved in iron acquisition.[59] Higher than normal concentrations of oxygen lead to increased levels of reactive oxygen species.[60] Oxygen is necessary for cell metabolism, and the blood supplies it to all parts of the body. When oxygen is breathed at high partial pressures, a hyperoxic condition will rapidly spread, with the most vascularised tissues being most vulnerable. During times of environmental stress, levels of reactive oxygen species can increase dramatically, which can damage cell structures and produce oxidative stress.[21][61]

While all the reaction mechanisms of these species within the body are not yet fully understood,[62] one of the most reactive products of oxidative stress is the hydroxyl radical (·OH), which can initiate a damaging chain reaction of lipid peroxidation in the unsaturated lipids within cell membranes.[63] High concentrations of oxygen also increase the formation of other free radicals, such as nitric oxide, peroxynitrite, and trioxidane, which harm DNA and other biomolecules.[21][64] Although the body has many antioxidant systems such as glutathione that guard against oxidative stress, these systems are eventually overwhelmed at very high concentrations of free oxygen, and the rate of cell damage exceeds the capacity of the systems that prevent or repair it.[65][66][67] Cell damage and cell death then result.[68]

## Diagnosis

[edit]

Diagnosis of central nervous system oxygen toxicity in divers prior to seizure is difficult as the symptoms of visual disturbance, ear problems, dizziness, confusion and nausea can be due to many factors common to the underwater environment such as narcosis, congestion and coldness. However, these symptoms may be helpful in diagnosing the first stages of oxygen toxicity in patients undergoing hyperbaric oxygen therapy. In either case, unless there is a prior history of epilepsy or tests indicate hypoglycaemia, a seizure occurring in the setting of breathing oxygen at partial pressures greater than 1.4 bar (140 kPa) suggests a diagnosis of oxygen toxicity.[69]

Diagnosis of bronchopulmonary dysplasia in newborn infants with breathing difficulties is difficult in the first few weeks. However, if the infant's breathing does not improve during this time, blood tests and x-rays may be used to confirm bronchopulmonary dysplasia. In addition, an echocardiogram can help to eliminate other possible causes such as congenital heart defects or pulmonary arterial hypertension.[70]

The diagnosis of retinopathy of prematurity in infants is typically suggested by the clinical setting. Prematurity, low birth weight, and a history of oxygen exposure are the principal indicators, while no hereditary factors have been shown to yield a pattern.[71]

### Differential diagnosis

[edit]

Clinical diagnosis can be confirmed with arterial oxygen levels.[28] A number of other conditions can be confused with oxygen toxicity, these include:[28]

* Carbon monoxide poisoning
* Cerebrovascular event (stroke)
* Envenomation or toxin ingestion
* Hypercapnia (Carbon dioxide narcosis)
* Hyperventilation
* Hypoglycemia
* Infection
* Migraine
* Multiple sclerosis
* Seizure disorder (epilepsy)

## Prevention

[edit]

The label on the diving cylinder shows that it contains oxygen-rich gas (36%) and is boldly marked with a maximum operating depth of 28 metres (92 ft)

The prevention of oxygen toxicity depends entirely on the setting. Both underwater and in space, proper precautions can eliminate the most pernicious effects. Premature infants commonly require supplemental oxygen to treat complications of preterm birth. In this case prevention of bronchopulmonary dysplasia and retinopathy of prematurity must be carried out without compromising a supply of oxygen adequate to preserve the infant's life.[72]

### Underwater

[edit]

See also: Maximum operating depth, Scuba gas planning, Rebreather diving, and Saturation diving

Oxygen toxicity is a catastrophic hazard in scuba diving, because a seizure results in high risk of death by drowning.[40][73] The seizure may occur suddenly and with no warning symptoms.[19] The effects are sudden convulsions and unconsciousness, during which victims can lose their regulator and drown.[74][75] One of the advantages of a full-face diving mask is prevention of regulator loss in the event of a seizure. Mouthpiece retaining straps are a relatively inexpensive alternative with a similar but less effective function.[73] As there is an increased risk of central nervous system oxygen toxicity on deep dives, long dives and dives where oxygen-rich breathing gases are used, divers are taught to calculate a maximum operating depth for oxygen-rich breathing gases, and cylinders containing such mixtures should be clearly marked with that depth.[24][76]

The risk of seizure appears to be a function of dose – a cumulative combination of partial pressure and duration. The threshold for oxygen partial pressure below which seizures never occur has not been established, and may depend on many variables, some of them personal. The risk to a specific person can vary considerably depending on individual sensitivity, level of exercise, and carbon dioxide retention, which is influenced by work of breathing.[73]

In some diver training courses for modes of diving in which exposure may reach levels with significant risk, divers are taught to plan and monitor what is called the 'oxygen clock' of their dives.[76] This is a notional alarm clock, which ticks more quickly at increased oxygen pressure and is set to activate at the maximum single exposure limit recommended in the National Oceanic and Atmospheric Administration Diving Manual.[24][76] For the following partial pressures of oxygen the limits are: 45 minutes at 1.6 bar (160 kPa), 120 minutes at 1.5 bar (150 kPa), 150 minutes at 1.4 bar (140 kPa), 180 minutes at 1.3 bar (130 kPa) and 210 minutes at 1.2 bar (120 kPa), but it is impossible to predict with any reliability whether or when toxicity symptoms will occur.[77][78] Many nitrox-capable dive computers calculate an oxygen loading and can track it across multiple dives. The aim is to avoid activating the alarm by reducing the partial pressure of oxygen in the breathing gas or by reducing the time spent breathing gas of greater oxygen partial pressure. As the partial pressure of oxygen increases with the fraction of oxygen in the breathing gas and the depth of the dive, the diver obtains more time on the oxygen clock by diving at a shallower depth, by breathing a less oxygen-rich gas, or by shortening the duration of exposure to oxygen-rich gases.[79][80] This function is provided by some technical diving decompression computers and rebreather control and monitoring hardware.[81][82]

Diving below 56 m (184 ft) on air would expose a diver to increasing danger of oxygen toxicity as the partial pressure of oxygen exceeds 1.4 bar (140 kPa), so a gas mixture should be used which contains less than 21% oxygen (termed a hypoxic mixture). Increasing the proportion of nitrogen is not viable, since it would produce a strongly narcotic mixture. However, helium is not narcotic, and a usable mixture may be blended either by completely replacing nitrogen with helium (the resulting mix is called heliox), or by replacing part of the nitrogen with helium, producing a trimix.[83]

Pulmonary oxygen toxicity is an entirely avoidable event while diving. The limited duration and naturally intermittent nature of most diving makes this a relatively rare (and even then, reversible) complication for divers.[84] Established guidelines enable divers to calculate when they are at risk of pulmonary toxicity.[85][86][87] In saturation diving it can be avoided by limiting the oxygen content of gas in living areas to below 0.4 bar.[88]

#### Screening

[edit]

The intention of screening using an oxygen tolerance test is to identify divers with low tolerance to high partial pressures of hyperbaric oxygen who may be more prone to oxygen convulsions during diving operations or during hyperbaric treatment for decompression sickness. The value of this test has been questioned, and statistical studies have shown low incidence of seizures during standard hyperbaric treatment schedules, so some navies have discontinued its use, though an others continue to require the test for all candidate divers.[89]

The variability in tolerance and other variable factors such as workload have resulted in the U.S. Navy abandoning screening for oxygen tolerance. Of the 6,250 oxygen-tolerance tests performed between 1976 and 1997, only 6 episodes of oxygen toxicity were observed (0.1%).[90][91]

The oxygen tolerance test used by the Indian Navy, which follows recommendations of the US Navy and US National Oceanic and Atmospheric Administration, is to breathe 100% oxygen delivered by BIBS mask at an ambient pressure of 2.8 bar absolute (18 msw) for 30 minutes, at rest in a dry hyperbaric chamber. No symptoms of CNS oxygen toxicity may be observed by the attendant.[89]

### Hyperbaric setting

[edit]

The presence of a fever or a history of seizure is a relative contraindication to hyperbaric oxygen treatment.[92] The schedules used for treatment of decompression illness allow for periods of breathing air rather than 100% oxygen (air breaks) to reduce the chance of seizure or lung damage. The U.S. Navy uses treatment tables based on periods alternating between 100% oxygen and air. For example, USN table 6 requires 75 minutes (three periods of 20 minutes oxygen/5 minutes air) at an ambient pressure of 2.8 standard atmospheres (280 kPa), equivalent to a depth of 18 metres (60 ft). This is followed by a slow reduction in pressure to 1.9 atm (190 kPa) over 30 minutes on oxygen. The patient then remains at that pressure for a further 150 minutes, consisting of two periods of 15 minutes air/60 minutes oxygen, before the pressure is reduced to atmospheric over 30 minutes on oxygen.[93]

Vitamin E and selenium were proposed and later rejected as a potential method of protection against pulmonary oxygen toxicity.[94][95][96] There is however some experimental evidence in rats that vitamin E and selenium aid in preventing in vivo lipid peroxidation and free radical damage, and therefore prevent retinal changes following repetitive hyperbaric oxygen exposures.[97]

### Normobaric setting

[edit]

Bronchopulmonary dysplasia is reversible in the early stages by use of break periods on lower pressures of oxygen, but it may eventually result in irreversible lung injury if allowed to progress to severe damage. One or two days of exposure without oxygen breaks are needed to cause such damage.[16]

Retinopathy of prematurity is largely preventable by screening. Current guidelines require that all babies of less than 32 weeks gestational age or having a birth weight less than 1.5 kg (3.3 lb) should be screened for retinopathy of prematurity at least every two weeks.[98] The National Cooperative Study in 1954 showed a causal link between supplemental oxygen and retinopathy of prematurity, but subsequent curtailment of supplemental oxygen caused an increase in infant mortality. To balance the risks of hypoxia and retinopathy of prematurity, modern protocols now require monitoring of blood oxygen levels in premature infants receiving oxygen.[99]

Careful titration of dosage to minimise delivered concentration while achieving the desired level of oxygenation will both minimise the risk of oxygen toxicity damage and the amount of oxygen used for long term therapy.[38] A typical target for oxygen saturation when receiving oxygen therapy, would be in the range of 91-95%, in both term and preterm infants.[72]

### Hypobaric setting

[edit]

In low-pressure environments oxygen toxicity may be avoided since the toxicity is caused by high partial pressure of oxygen, not by high oxygen fraction. This is illustrated by the use of pure oxygen in spacesuits, which must operate at low pressure, and a high oxygen fraction and cabin pressure lower than normal atmospheric pressure in early spacecraft, for example, the Gemini and Apollo spacecraft.[100] In such applications as extra-vehicular activity, high-fraction oxygen is non-toxic, even at breathing mixture fractions approaching 100%, because the oxygen partial pressure is not allowed to chronically exceed 0.3 bar (4.4 psi).[100]

## Management

[edit]

The retina (red) is detached at the top of the eye. The silicone band (scleral buckle, blue) is placed around the eye. This brings the wall of the eye into contact with the detached retina, allowing the retina to re-attach.

During hyperbaric oxygen therapy, the patient will usually breathe 100% oxygen from a mask while inside a hyperbaric chamber pressurised with air to about 2.8 bar (280 kPa). Seizures during the therapy are managed by removing the mask from the patient, thereby dropping the partial pressure of oxygen inspired below 0.6 bar (60 kPa).[19]

A seizure underwater requires that the diver be brought to the surface as soon as practicable. Although for many years the recommendation has been not to raise the diver during the seizure itself, owing to the danger of arterial gas embolism (AGE),[101] there is some evidence that the glottis does not fully obstruct the airway.[102] This has led to the current recommendation by the Diving Committee of the Undersea and Hyperbaric Medical Society that a diver should be raised during the seizure's clonic (convulsive) phase if the regulator is not in the diver's mouth—as the danger of drowning is then greater than that of AGE—but the ascent should be delayed until the end of the clonic phase otherwise.[74] Rescuers ensure that their own safety is not compromised during the convulsive phase. They then ensure that where the victim's air supply is established it is maintained, and carry out a controlled buoyant lift. Lifting an unconscious body is taught by most recreational diver training agencies as an advanced skill, and for professional divers it is a basic skill, as it is one of the primary functions of the standby diver. Upon reaching the surface, emergency services are always contacted as there is a possibility of further complications requiring medical attention.[103] If symptoms develop other than a seizure underwater the diver should immediately switch to a gas with a lower oxygen fraction or ascend to a shallower depth if decompression obligations allow. If a chamber is available at the surface, surface decompression is a recommended option. The U.S. Navy has published procedures for completing decompression stops where a recompression chamber is not immediately available.[104] Some dive computers will recalculate decompression requirements for alternative mixtures provided the actual gas setting is activated.[81]

The occurrence of symptoms of bronchopulmonary dysplasia or acute respiratory distress syndrome is treated by lowering the fraction of oxygen administered, along with a reduction in the periods of exposure and an increase in the break periods where normal air is supplied. Where supplemental oxygen is required for treatment of another disease (particularly in infants), a ventilator may be needed to ensure that the lung tissue remains inflated. Reductions in pressure and exposure will be made progressively, and medications such as bronchodilators and pulmonary surfactants may be used.[105]

Divers manage the risk of pulmonary damage by limiting exposure to levels shown to be generally acceptable by experimental evidence, using a system of accumulated oxygen toxicity units which are based on exposure time at specified partial pressures. In the event of emergency treatment for decompression illness, it may be necessary to exceed normal exposure limits to manage more critical symptoms.[34]

Retinopathy of prematurity may regress spontaneously, but should the disease progress beyond a threshold (defined as five contiguous or eight cumulative hours of stage 3 retinopathy of prematurity), both cryosurgery and laser surgery have been shown to reduce the risk of blindness as an outcome. Where the disease has progressed further, techniques such as scleral buckling and vitrectomy surgery may assist in re-attaching the retina.[106]

### Repetitive exposure

[edit]

Repeated exposure to potentially toxic oxygen concentrations in breathing gas is fairly common in hyperbaric activity, particularly in hyperbaric medicine, saturation diving, underwater habitats, and repetitive decompression diving. Research at the National Oceanic and Atmospheric Administration (NOAA) by R.W. Hamilton and others determined acceptable levels of exposure for single and repeated exposures. A distinction is made between acceptable exposure for acute and chronic toxicity, but these are really the extremes of a possible continuous range of exposures. A further distinction can be made between routine exposure and exposure required for emergency treatment, where a higher risk of oxygen toxicity may be justified to achieve a reduction of a more critical injury, particularly when in a relatively safe controlled and monitored environment.[34][93]

The Repex (repetitive exposure) method, developed in 1988, allows oxygen toxicity dosage to be calculated using a single dose value equivalent to 1 minute of 100% oxygen at atmospheric pressure called an Oxygen Tolerance Unit (OTU), and is used to avoid toxic effects over several days of operational exposure. Some dive computers will automatically track the dosage based on measured depth and selected gas mixture. The limits allow a greater exposure when the person has not been exposed recently, and daily allowable dose decreases with an increase in consecutive days with exposure.[34] These values may not be fully supported by current data.[107]

NOAA REPEX limits for whole-body exposure in multiple day oxygen exposures[34] Days of exposure | average daily dose (OTU) | total dose (OTU)

|
|

1 | 850 | 850
2 | 700 | 1400
3 | 620 | 1860
4 | 525 | 2100
5 | 460 | 2300
6 | 420 | 2520
7 | 380 | 2660
8 | 350 | 2800
9 | 330 | 2970
10 | 310 | 3100
11 to 30 | 300 | as calculated
Oxygen toxicity units per minute at varying partial pressure[34] PO2 (atm) | OTU per minute

|

0.50 | 0.00
0.55 | 0.15
0.60 | 0.27
0.65 | 0.37
0.70 | 0.47
0.75 | 0.56
0.80 | 0.65
0.85 | 0.74
0.90 | 0.83
0.95 | 0.92
1.00 | 1.00
1.05 | 1.08
1.10 | 1.16
1.15 | 1.24
1.20 | 1.32
1.25 | 1.40
1.30 | 1.48
1.35 | 1.55
1.40 | 1.63
1.45 | 1.70
1.50 | 1.78
1.55 | 1.85
1.60 | 1.92
1.65 | 2.00
1.70 | 2.07
1.75 | 2.14
1.80 | 2.21
1.85 | 2.28
1.90 | 2.35
1.95 | 2.42
2.00 | 2.49

A more recent proposal uses a simple power equation, Toxicity Index (TI) = t2 × PO2c, where t is time and c is the power term. This was derived from the chemical reactions producing reactive oxygen or nitrogen species, and has been shown to give good predictions for CNS toxicity with c = 6.8 and for pulmonary toxicity for c = 4.57.[107]

For pulmonary toxicity, time is in hours, and PO2 in atmospheres absolute, TI should be limited to 250.

For CNS toxicity, time is in minutes, PO2 in atmospheres absolute, and a TI of 26,108 indicates a 1% risk.

## Prognosis

[edit]

Although the convulsions caused by central nervous system oxygen toxicity may lead to incidental injury to the victim, it remained uncertain for many years whether damage to the nervous system following the seizure could occur and several studies searched for evidence of such damage. An overview of these studies by Bitterman in 2004 concluded that following removal of breathing gas containing high fractions of oxygen, no long-term neurological damage from the seizure remains.[21][108]

The majority of infants who have survived following an incidence of bronchopulmonary dysplasia will eventually recover near-normal lung function, since lungs continue to grow during the first 5–7 years and the damage caused by bronchopulmonary dysplasia is to some extent reversible (even in adults). However, they are likely to be more susceptible to respiratory infections for the rest of their lives and the severity of later infections is often greater than that in their peers.[109][110]

Retinopathy of prematurity (ROP) in infants frequently regresses without intervention and eyesight may be normal in later years. Where the disease has progressed to the stages requiring surgery, the outcomes are generally good for the treatment of stage 3 ROP, but are much worse for the later stages. Although surgery is usually successful in restoring the anatomy of the eye, damage to the nervous system by the progression of the disease leads to comparatively poorer results in restoring vision. The presence of other complicating diseases also reduces the likelihood of a favourable outcome.[111]

Provision of supplementary oxygen remains of life-saving importance in critical care, and can increase survival in some chronic conditions, but hyperoxia and the formation of reactive oxygen species is involved in the pathogenesis of several life-threatening diseases. The toxic effects of hyperoxia are particularly prevalent in the pulmonary compartment, and cerebral and coronary circulations are at risk when vascular changes occur. Long-term hyperoxia harms the immune responses and susceptibility to infectious complications and tissue injury are increased.[38]

## Epidemiology

[edit]

Retinopathy of prematurity (ROP) in 1997 was more common in middle income countries where neonatal intensive care services were increasing; but greater awareness of the problem, leading to preventive measures, had not yet occurred.[37]

The incidence of central nervous system toxicity among divers has decreased since the Second World War, as protocols have developed to limit exposure and partial pressure of oxygen inspired. In 1947, Donald recommended limiting the depth allowed for breathing pure oxygen to 7.6 m (25 ft), which equates to an oxygen partial pressure of 1.8 bar (180 kPa).[112] Over time this limit has been reduced, until today a limit of 1.4 bar (140 kPa) during a recreational dive and 1.6 bar (160 kPa) during shallow decompression stops is generally recommended,[113] though military divers using oxygen rebreathers may operate to greater depths for limited periods, at greater risk.[114] Oxygen toxicity has now become a rare occurrence other than when caused by equipment malfunction and human error. Historically, the U.S. Navy has refined its Navy Diving Manual air and mixed gas tables to reduce oxygen toxicity incidents. Between 1995 and 1999, reports showed 405 surface-supported dives using the helium–oxygen tables; of these, oxygen toxicity symptoms were observed on 6 dives (1.5%). As a result, the U.S. Navy in 2000 modified the schedules and conducted field tests of 150 dives, none of which produced symptoms of oxygen toxicity. Revised tables were published in 2001.[115]

The variability in tolerance and other variable factors such as workload have resulted in the U.S. Navy abandoning screening for oxygen tolerance. Of the 6,250 oxygen-tolerance tests performed between 1976 and 1997, only 6 episodes of oxygen toxicity were observed (0.1%).[90][91]

Central nervous system oxygen toxicity among patients undergoing hyperbaric oxygen therapy is rare, and is influenced by a number of a factors: individual sensitivity and treatment protocol; and probably therapy indication and equipment used. A study by Welslau in 1996 reported 16 incidents out of a population of 107,264 patients (0.015%), while Hampson and Atik in 2003 found a rate of 0.03%.[116][117] Yildiz, Ay and Qyrdedi, in a summary of 36,500 patient treatments between 1996 and 2003, reported only 3 oxygen toxicity incidents, giving a rate of 0.008%.[116] A later review of over 80,000 patient treatments revealed an even lower rate: 0.0024%. The reduction in incidence may be partly due to use of a mask rather than a hood to deliver oxygen as there is less dead space in a mask.[118]

The overall risk of CNS toxicity may be as high as 1 in 2000 to 3000 treatments. but it varies with the pressure and may be as high as 1 in 200 at higher pressure treatment schedules of 2.8 to 3.0 ATA, or as low as 1 in 10,000 for schedules at 2 ATA or less.[28]

Bronchopulmonary dysplasia is among the most common complications of prematurely born infants and its incidence has grown as the survival of extremely premature infants has increased. Nevertheless, the severity has decreased as better management of supplemental oxygen has resulted in the disease now being related mainly to factors other than hyperoxia.[45]

In 1997 a summary of studies of neonatal intensive care units in industrialised countries showed that up to 60% of low birth weight babies developed retinopathy of prematurity, which rose to 72% in extremely low birth weight babies, defined as less than 1 kg (2.2 lb) at birth. However, severe outcomes are much less frequent: for very low birth weight babies—those less than 1.5 kg (3.3 lb) at birth—the incidence of blindness was found to be no more than 8%.[37]

Administration of supplemental oxygen is extensively and effectively used in emergency and intensive care medicine, but the reactive oxygen species caused by excessive oxygenation tend to cause a vicious cycle of tissue injury, characterized by cell damage, cell death, and inflammation, mostly in the lungs, which can exacerbate problems of tissue oxygenation for which the supplemental oxygen was intended as a treatment. Similar problems can occur in oxygen therapy for chronic conditions which involve hypoxia. Careful titration of oxygen supply to minimise the excess to physiological need also reduces pulmonary hyperoxic exposure to the reasonably practicable minimum.[38] The incidence of pulmonary symptoms of oxygen toxicity is about 5%, and some drugs can increase the risk, such as the chemotherapeutic agent bleomycin.[28]

## History

[edit]

Paul Bert, a French physiologist, first described oxygen toxicity in 1878.

Central nervous system toxicity was first described by Paul Bert in 1878.[119][120] He showed that oxygen was toxic to insects, arachnids, myriapods, molluscs, earthworms, fungi, germinating seeds, birds, and other animals. Central nervous system toxicity may be referred to as the "Paul Bert effect".[16]

Pulmonary oxygen toxicity was first described by J. Lorrain Smith in 1899 when he noted central nervous system toxicity and discovered in experiments in mice and birds that 0.43 bar (43 kPa) had no effect but 0.75 bar (75 kPa) of oxygen was a pulmonary irritant.[33] Pulmonary toxicity may be referred to as the "Lorrain Smith effect".[16] The first recorded human exposure was undertaken in 1910 by Bornstein when two men breathed oxygen at 2.8 bar (280 kPa) for 30 minutes, while he went on to 48 minutes with no symptoms. In 1912, Bornstein developed cramps in his hands and legs while breathing oxygen at 2.8 bar (280 kPa) for 51 minutes.[3] Smith then went on to show that intermittent exposure to a breathing gas with less oxygen permitted the lungs to recover and delayed the onset of pulmonary toxicity.[33]

Albert R. Behnke et al. in 1935 were the first to observe visual field contraction (tunnel vision) on dives between 1.0 bar (100 kPa) and 4.1 bar (410 kPa).[121][122] During World War II, Donald and Yarbrough et al. performed over 2,000 experiments on oxygen toxicity to support the initial use of closed circuit oxygen rebreathers.[46][123] Naval divers in the early years of oxygen rebreather diving developed a mythology about a monster called "Oxygen Pete", who lurked in the bottom of the Admiralty Experimental Diving Unit "wet pot" (a water-filled hyperbaric chamber) to catch unwary divers. They called having an oxygen toxicity attack "getting a Pete".[124][125]

In the decade following World War II, Lambertsen et al. made further discoveries on the effects of breathing oxygen under pressure and methods of prevention.[126][127] Their work on intermittent exposures for extension of oxygen tolerance and on a model for prediction of pulmonary oxygen toxicity based on pulmonary function are key documents in the development of standard operating procedures when breathing increased pressures of oxygen.[128] Lambertsen's work showing the effect of carbon dioxide in decreasing time to onset of central nervous system symptoms has influenced work from current exposure guidelines to future breathing apparatus design.[23][24][129]

Retinopathy of prematurity was not observed before World War II, but with the availability of supplemental oxygen in the decade following, it rapidly became one of the principal causes of infant blindness in developed countries. By 1960 the use of oxygen had become identified as a risk factor and its administration restricted. The resulting fall in retinopathy of prematurity was accompanied by a rise in infant mortality and hypoxia-related complications. Since then, more sophisticated monitoring and diagnosis have established protocols for oxygen use which aim to balance between hypoxic conditions and problems of retinopathy of prematurity.[37]

Bronchopulmonary dysplasia was first described by Northway in 1967, who outlined the conditions that would lead to the diagnosis.[130] This was later expanded by Bancalari and in 1988 by Shennan, who suggested the need for supplemental oxygen at 36 weeks could predict long-term outcomes.[131] Nevertheless, Palta et al. in 1998 concluded that radiographic evidence was the most accurate predictor of long-term effects.[132]

Robert W. Hamilton Jr, lead researcher on tolerable repetitive exposure limits at NOAA.

Bitterman et al. in 1986 and 1995 showed that darkness and caffeine would delay the onset of changes to brain electrical activity in rats.[25][26] In the years since, research on central nervous system toxicity has centred on methods of prevention and safe extension of tolerance.[133] Sensitivity to central nervous system oxygen toxicity has been shown to be affected by factors such as circadian rhythm, drugs, age, and gender.[134][135][136][137] In 1988, Hamilton et al. wrote procedures for the National Oceanic and Atmospheric Administration to establish oxygen exposure limits for habitat operations.[85][86][87] Even today, models for the prediction of pulmonary oxygen toxicity do not explain all the results of exposure to high partial pressures of oxygen.[138]

## Society and culture

[edit]

See also: Nitrox and Oxygen bar

Recreational scuba divers commonly breathe nitrox containing up to 40% oxygen, while technical divers use pure oxygen or nitrox containing up to 80% oxygen to accelerate decompression. Divers who breathe oxygen fractions greater than of air (21%) need to be educated on the dangers of oxygen toxicity and how to manage the risk.[76] To buy nitrox, a diver may be required to show evidence of relevant qualification.[139]

Since the late 1990s the recreational use of oxygen has been promoted by oxygen bars, where customers breathe oxygen through a nasal cannula. Claims have been made that this reduces stress, increases energy, and lessens the effects of hangovers and headaches, despite the lack of any scientific evidence to support them.[140] There are also devices on sale that offer "oxygen massage" and "oxygen detoxification" with claims of removing body toxins and reducing body fat.[141] The American Lung Association has stated "there is no evidence that oxygen at the low flow levels used in bars can be dangerous to a normal person's health", but the U.S. Center for Drug Evaluation and Research cautions that people with heart or lung disease need their supplementary oxygen carefully regulated and should not use oxygen bars.[140]

Victorian society had a fascination for the rapidly expanding field of science. In "Dr. Ox's Experiment", a short story written by Jules Verne in 1872, the eponymous doctor uses electrolysis of water to separate oxygen and hydrogen. He then pumps the pure oxygen throughout the town of Quiquendone, causing the normally tranquil inhabitants and their animals to become aggressive and plants to grow rapidly. An explosion of the hydrogen and oxygen in Dr Ox's factory brings his experiment to an end. Verne summarised his story by explaining that the effects of oxygen described in the tale were his own invention (they are not in any way supported by empirical evidence).[142] There is also a brief episode of oxygen intoxication in his "From the Earth to the Moon".[143]

## See also

[edit]

* Effect of oxygen on chronic obstructive pulmonary disease
* Hypercapnia – Abnormally high tissue carbon dioxide levels
* Nitrogen narcosis – Narcotic effects of respiratory nitrogen

## References

[edit]

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83. ^ Hamilton & Thalmann 2003, pp. 475, 479.
84. ^ Clark & Lambertsen 1970, p. 270.
85. ^ a b Hamilton, RW; Kenyon, David J; Peterson, RE; Butler, GJ; Beers, DM (1988). "Repex habitat diving procedures: Repetitive vertical excursions, oxygen limits, and surfacing techniques". Technical Report 88-1A. Rockville, MD: NOAA Office of Undersea Research. Archived from the original on 22 November 2008. Retrieved 29 April 2008.
86. ^ a b Hamilton, Robert W; Kenyon, David J; Peterson, RE (1988). "Repex habitat diving procedures: Repetitive vertical excursions, oxygen limits, and surfacing techniques". Technical Report 88-1B. Rockville, MD: NOAA Office of Undersea Research. Archived from the original on 22 November 2008. Retrieved 29 April 2008.
87. ^ a b Hamilton, Robert W (1997). "Tolerating oxygen exposure". South Pacific Underwater Medicine Society Journal. 27 (1). ISSN 0813-1988. OCLC 16986801. Archived from the original on 20 August 2008. Retrieved 29 April 2008.
88. ^ Kot, Jacek; Sicko, Zdzislaw; Doboszynski, Tadeusz (2015). "The Extended Oxygen Window Concept for Programming Saturation Decompressions Using Air and Nitrox". PLOS ONE. 10 (6): 1–20\. Bibcode:2015PLoSO..1030835K. doi:10.1371/journal.pone.0130835. PMC 4482426. PMID 26111113.
89. ^ a b Ghosh, D.K.; Kodange, C.; Mohanty, C.S.; Sarkar, S.; Verma, Rohit (2015). "Oxygen tolerance test : A standardised protocol". Journal of Marine Medical Society. 17: 30. doi:10.4103/0975-3605.203391. S2CID 100427932.
90. ^ a b Walters, KC; Gould, MT; Bachrach, EA; Butler, Frank K (2000). "Screening for oxygen sensitivity in U.S. Navy combat swimmers". Undersea and Hyperbaric Medicine. 27 (1): 21–26\. PMID 10813436. Archived from the original on 7 October 2008. Retrieved 2 October 2008.
91. ^ a b Butler, Frank K; Knafelc, ME (1986). "Screening for oxygen intolerance in U.S. Navy divers". Undersea Biomedical Research. 13 (1): 91–98\. PMID 3705251. Archived from the original on 20 August 2008. Retrieved 2 October 2008.
92. ^ Latham, Emi (7 November 2008). "Hyperbaric Oxygen Therapy: Contraindications". Medscape. Retrieved 25 September 2008.
93. ^ a b U.S. Navy Diving Manual 2011, p. 41, vol. 5, ch. 20.
94. ^ Schatte, CL (1977). "Dietary selenium and vitamin E as a possible prophylactic to pulmonary oxygen poisoning". Proceedings of the Sixth International Congress on Hyperbaric Medicine, University of Aberdeen, Aberdeen, Scotland. Aberdeen: Aberdeen University Press: 84–91\. ISBN 0-08-024918-3. OCLC 16428246.
95. ^ Boadi, WY; Thaire, L; Kerem, D; Yannai, S (1991). "Effects of dietary supplementation with vitamin E, riboflavin and selenium on central nervous system oxygen toxicity". Pharmacology & Toxicology. 68 (2): 77–82\. doi:10.1111/j.1600-0773.1991.tb02039.x. PMID 1852722.
96. ^ Piantadosi, Claude A (2006). In: The Mysterious Malady: Toward an understanding of decompression injuries (DVD). Global Underwater Explorers. Retrieved 2 April 2012.
97. ^ Stone, WL; Henderson, RA; Howard, GH; Hollis, AL; Payne, PH; Scott, RL (1989). "The role of antioxidant nutrients in preventing hyperbaric oxygen damage to the retina". Free Radical Biology & Medicine. 6 (5): 505–12\. doi:10.1016/0891-5849(89)90043-9. PMID 2744583.
98. ^ "UK Retinopathy of Prematurity Guideline" (PDF). Royal College of Paediatrics and Child Health, Royal College of Ophthalmologists & British Association of Perinatal Medicine. 2007. p. i. Archived from the original (PDF) on 18 February 2012. Retrieved 2 April 2009.
99. ^ Silverman, William (1980). Retrolental Fibroplasia: A Modern Parable. Grune & Stratton. pp. 39, 41, 143. ISBN 978-0-8089-1264-4.
100. ^ a b Webb, James T; Olson, RM; Krutz, RW; Dixon, G; Barnicott, PT (1989). "Human tolerance to 100% oxygen at 9.5 psia during five daily simulated 8-hour EVA exposures". Aviation, Space, and Environmental Medicine. 60 (5): 415–21\. doi:10.4271/881071. PMID 2730484.
101. ^ U.S. Navy Diving Manual 2011, p. 45, vol. 1, ch. 3.
102. ^ Mitchell, Simon J (20 January 2008). "Standardizing CCR rescue skills". RebreatherWorld. Archived from the original on 3 March 2012. Retrieved 26 May 2009. This forum post's author chairs the diving committee of the Undersea and Hyperbaric Medical Society.
103. ^ Thalmann, Edward D (2 December 2003). "OXTOX: If You Dive Nitrox You Should Know About OXTOX". Divers Alert Network. Retrieved 11 October 2015. – Section "What do you do if oxygen toxicity or a convulsion happens?"
104. ^ U.S. Navy Diving Manual 2011, pp. 37–39, vol. 2, ch. 9.
105. ^ "NIH MedlinePlus: Bronchopulmonary dysplasia". U.S. National Library of Medicine. Retrieved 2 October 2008.
106. ^ Regillo, Brown & Flynn 1998, p. 184.
107. ^ a b Arieli, R. (30 September 2019). "Calculated risk of pulmonary and central nervous system oxygen toxicity: a toxicity index derived from the power equation". Diving Hyperb Med. 49 (3): 154–160\. doi:10.28920/dhm49.3.154-160. PMC 6881196. PMID 31523789.
108. ^ Lambertsen, Christian J (1965). Fenn, WO; Rahn, H (eds.). "Effects of oxygen at high partial pressure". Handbook of Physiology: Respiration. Sec 3 Vol 2. American Physiological Society: 1027–46.
109. ^ "National Institutes of Health: What is bronchopulmonary dysplasia?". U.S. Department of Health & Human Services. Retrieved 2 October 2008.
110. ^ Spear, Michael L – reviewer (June 2008). "Bronchopulmonary dysplasia (BPD)". Nemours Foundation. Retrieved 3 October 2008.
111. ^ Regillo, Brown & Flynn 1998, p. 190.
112. ^ Donald, Part II 1947.
113. ^ Lang 2001, p. 183.
114. ^ Wingelaar, T.T.; van Ooij, P.A.M; Van Hulst, R.A. (2017). "Oxygen Toxicity and Special Operations Forces Diving: Hidden and Dangerous". Frontiers in Psychology. 8: 1263. doi:10.3389/fpsyg.2017.01263. PMC 5524741. PMID 28790955.
115. ^ Gerth, Wayne A (2006). "Decompression sickness and oxygen toxicity in U.S. Navy surface-supplied He-O2 diving". Proceedings of Advanced Scientific Diving Workshop. Smithsonian Institution. Archived from the original on 21 February 2009. Retrieved 2 October 2008.
116. ^ a b Yildiz, S; Ay, H; Qyrdedi, T (2004). "Central nervous system oxygen toxicity during routine hyperbaric oxygen therapy". Undersea and Hyperbaric Medicine. 31 (2). Undersea and Hyperbaric Medical Society, Inc: 189–90\. PMID 15485078. Archived from the original on 13 January 2013. Retrieved 3 October 2008.
117. ^ Hampson, Neal; Atik, D (2003). "Central nervous system oxygen toxicity during routine hyperbaric oxygen therapy". Undersea and Hyperbaric Medicine. 30 (2). Undersea and Hyperbaric Medical Society, Inc: 147–53\. PMID 12964858. Archived from the original on 13 January 2013. Retrieved 20 October 2008.
118. ^ Yildiz, S; Aktas, S; Cimsit, M; Ay, H; Togrol, E (2004). "Seizure incidence in 80,000 patient treatments with hyperbaric oxygen". Aviation, Space, and Environmental Medicine. 75 (11): 992–94\. PMID 15559001. Retrieved 1 July 2009.
119. ^ Bert, Paul (1943) [First published in French in 1878]. Barometric pressure: Researches in Experimental Physiology. Columbus, OH: College Book Company. Translated by: Hitchcock, Mary Alice; Hitchcock, Fred A
120. ^ British Sub-aqua Club (1985). Sport diving : the British Sub-Aqua Club diving manual. London: Stanley Paul. p. 110\. ISBN 0-09-163831-3. OCLC 12807848.
121. ^ Behnke, Alfred R; Johnson, FS; Poppen, JR; Motley, EP (1935). "The effect of oxygen on man at pressures from 1 to 4 atmospheres". American Journal of Physiology. 110 (3): 565–72\. doi:10.1152/ajplegacy.1934.110.3.565. Note: 1 atmosphere (atm) is 1.013 bars.
122. ^ Behnke, Alfred R; Forbes, HS; Motley, EP (1935). "Circulatory and visual effects of oxygen at 3 atmospheres pressure". American Journal of Physiology. 114 (2): 436–42\. doi:10.1152/ajplegacy.1935.114.2.436. Note: 1 atmosphere (atm) is 1.013 bars.
123. ^ Donald 1992.
124. ^ Taylor, Larry "Harris" (1993). "Oxygen Enriched Air: A New Breathing Mix?". IANTD Journal. Archived from the original on 10 June 2020. Retrieved 29 May 2008.
125. ^ Davis, Robert H (1955). Deep Diving and Submarine Operations (6th ed.). Tolworth, Surbiton, Surrey: Siebe Gorman & Company Ltd. p. 291.
126. ^ Lambertsen, Christian J; Clark, John M; Gelfand, R (2000). "The Oxygen research program, University of Pennsylvania: Physiologic interactions of oxygen and carbon dioxide effects and relations to hyperoxic toxicity, therapy, and decompression. Summation: 1940 to 1999". EBSDC-IFEM Report No. 3-1-2000. Philadelphia, PA: Environmental Biomedical Stress Data Center, Institute for Environmental Medicine, University of Pennsylvania Medical Center.
127. ^ Vann, Richard D (2004). "Lambertsen and O2: Beginnings of operational physiology". Undersea and Hyperbaric Medicine. 31 (1): 21–31\. PMID 15233157. Archived from the original on 13 June 2008. Retrieved 29 April 2008.
128. ^ Clark & Lambertsen 1970.
129. ^ Lang 2001, pp. 81–86.
130. ^ Northway, WH; Rosan, RC; Porter, DY (1967). "Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia". New England Journal of Medicine. 276 (7): 357–68\. doi:10.1056/NEJM196702162760701. PMID 5334613.
131. ^ Shennan, AT; Dunn, MS; Ohlsson, A; Lennox, K; Hoskins, EM (1988). "Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period". Pediatrics. 82 (4): 527–32\. doi:10.1542/peds.82.4.527. PMID 3174313. S2CID 2398582.
132. ^ Palta, Mari; Sadek, Mona; Barnet, Jodi H; et al. (January 1998). "Evaluation of criteria for chronic lung disease in surviving very low birth weight infants. Newborn Lung Project". Journal of Pediatrics. 132 (1): 57–63\. doi:10.1016/S0022-3476(98)70485-8. PMID 9470001.
133. ^ Natoli, MJ; Vann, Richard D (1996). "Factors Affecting CNS Oxygen Toxicity in Humans". Report to the U.S. Office of Naval Research. Durham, NC: Duke University. Archived from the original on 20 August 2008. Retrieved 29 April 2008.
134. ^ Hof, DG; Dexter, JD; Mengel, CE (1971). "Effect of circadian rhythm on CNS oxygen toxicity". Aerospace Medicine. 42 (12): 1293–96\. PMID 5130131.
135. ^ Torley, LW; Weiss, HS (1975). "Effects of age and magnesium ions on oxygen toxicity in the neonate chicken". Undersea Biomedical Research. 2 (3): 223–27\. PMID 15622741. Archived from the original on 13 January 2013. Retrieved 20 September 2008.
136. ^ Troy, SS; Ford, DH (1972). "Hormonal protection of rats breathing oxygen at high pressure". Acta Neurologica Scandinavica. 48 (2): 231–42\. doi:10.1111/j.1600-0404.1972.tb07544.x. PMID 5061633. S2CID 28618515.
137. ^ Hart, George B; Strauss, Michael B (2007). "Gender differences in human skeletal muscle and subcutaneous tissue gases under ambient and hyperbaric oxygen conditions". Undersea and Hyperbaric Medicine. 34 (3): 147–61\. PMID 17672171. Archived from the original on 13 January 2013. Retrieved 20 September 2008.
138. ^ Shykoff, Barbara E (2007). "Performance of various models in predicting vital capacity changes caused by breathing high oxygen partial pressures". Nedu-Tr-07-13. Panama City, FL: U.S. Naval Experimental Diving Unit Technical Report. Archived from the original on 22 November 2008. Retrieved 6 June 2008.
139. ^ British Sub-Aqua Club (2006). "The Ocean Diver Nitrox Workshop" (PDF). British Sub-Aqua Club. p. 6\. Archived from the original (PDF) on 16 July 2011. Retrieved 15 September 2010.
140. ^ a b Bren, Linda (November–December 2002). "Oxygen Bars: Is a Breath of Fresh Air Worth It?". FDA Consumer. Vol. 36, no. 6\. pp. 9–11\. PMID 12523293. Retrieved 25 March 2020.
141. ^ "O2 Planet – Exercise and Fitness Equipment". O2Planet LLC. 2006. Archived from the original on 15 April 2006. Retrieved 21 October 2008.
142. ^ Verne, Jules (2004) [1872]. A Fantasy of Dr Ox. Hesperus Press. ISBN 978-1-84391-067-1. Retrieved 8 May 2009. Translated from French
143. ^ Verne, Jules (1877) [1870]. "VIII" [At seventy-eight thousand one hundred and fourteen leagues]. Autour de la Lune [Round the Moon]. London: Ward Lock. ISBN 2-253-00587-8. Retrieved 2 September 2009. `{{cite book}}`: ISBN / Date incompatibility (help) Translated from French

## Sources

[edit]

* Clark, James M; Thom, Stephen R (2003). "Oxygen under pressure". In Brubakk, Alf O; Neuman, Tom S (eds.). Bennett and Elliott's physiology and medicine of diving (5th ed.). United States: Saunders. pp. 358–418\. ISBN 978-0-7020-2571-6. OCLC 51607923.
* Clark, John M; Lambertsen, Christian J (1970). "Pulmonary oxygen tolerance in man and derivation of pulmonary oxygen tolerance curves". IFEM Report No. 1-70. Philadelphia, PA: Environmental Biomedical Stress Data Center, Institute for Environmental Medicine, University of Pennsylvania Medical Center.
* Donald, Kenneth W (1947). "Oxygen Poisoning in Man: Part I". British Medical Journal. 1 (4506): 667–72\. doi:10.1136/bmj.1.4506.667. PMC 2053251. PMID 20248086.
* Donald, Kenneth W (1947). "Oxygen Poisoning in Man: Part II". British Medical Journal. 1 (4507): 712–17\. doi:10.1136/bmj.1.4507.712. PMC 2053400. PMID 20248096.
* Revised version of Donald's articles also available as:
* Donald, Kenneth W (1992). Oxygen and the diver. UK: Harley Swan, 237 pages. ISBN 1-85421-176-5. OCLC 26894235.
* Hamilton, Robert W; Thalmann, Edward D (2003). "Decompression practice". In Brubakk, Alf O; Neuman, Tom S (eds.). Bennett and Elliott's physiology and medicine of diving (5th ed.). United States: Saunders. pp. 475–79\. ISBN 978-0-7020-2571-6. OCLC 51607923.
* Lang, Michael A, ed. (2001). DAN nitrox workshop proceedings. Durham, NC: Divers Alert Network, 197 pages.
* Regillo, Carl D; Brown, Gary C; Flynn, Harry W (1998). Vitreoretinal Disease: The Essentials. New York: Thieme, 693 pages. ISBN 978-0-86577-761-3. OCLC 39170393.
* U.S. Navy Supervisor of Diving (2011). U.S. Navy Diving Manual (PDF). SS521-AG-PRO-010 0910-LP-106-0957, revision 6 with Change A entered. U.S. Naval Sea Systems Command. Archived from the original (PDF) on 10 December 2014. Retrieved 29 January 2015.

## Further reading

[edit]

* Lamb, John S. (1999). The Practice of Oxygen Measurement for Divers. Flagstaff: Best Publishing, 120 pages. ISBN 0-941332-68-3. OCLC 44018369.
* Lippmann, John; Bugg, Stan (1993). The Diving Emergency Handbook. Teddington, UK: Underwater World Publications. ISBN 0-946020-18-3. OCLC 52056845.
* Lippmann, John; Mitchell, Simon (2005). "Oxygen". Deeper into Diving (2nd ed.). Victoria, Australia: J.L. Publications. pp. 121–24\. ISBN 0-9752290-1-X. OCLC 66524750.

## External links

[edit]

The following external sites contain resources specific to particular topics:

* 2008 Divers Alert Network Technical Diving Conference – Video of "Oxygen Toxicity" lecture by Dr. Richard Vann (free download, mp4, 86MB).
* Nosek, Thomas M. "Section 4/4ch7/s4ch7_7". Essentials of Human Physiology. Archived from the original on 24 March 2016. – Discussion of the effects of breathing oxygen on the respiratory system.
* Rajiah, Prabhakar (11 March 2009). "Bronchopulmonary Dysplasia". eMedicine. WebMD. Retrieved 29 June 2009. – Clinical overview with references.

Classification|

* ICD-10: T59.8
* ICD-9-CM: 987.8
* MeSH: D018496

|

* v
* t
* e

Respiratory physiology

Respiration|

* breath
* inhalation
* exhalation
* obligate nasal breathing
* respiratory rate
* respirometer
* pulmonary surfactant
* compliance
* elastic recoil
* hysteresivity
* airway resistance
* bronchial
* hyperresponsiveness
* constriction
* dilatation
* mechanical ventilation

Control|

* pons
* pneumotaxic center
* apneustic center
* medulla
* dorsal respiratory group
* ventral respiratory group
* chemoreceptors
* central
* peripheral
* pulmonary stretch receptor
* Hering–Breuer reflex

Lung volumes|

* VC
* FRC
* Vt
* dead space
* CC
* PEF

calculations

respiratory minute volume
FEV1/FVC ratio

Lung function tests

spirometry
body plethysmography
peak flow meter
nitrogen washout

Circulation|

* pulmonary circulation
* hypoxic pulmonary vasoconstriction
* pulmonary shunt

Interactions|

* ventilation (V)
* Perfusion (Q)
* Ventilation/perfusion ratio
* V/Q scan
* zones of the lung
* gas exchange
* pulmonary gas pressures
* alveolar gas equation
* alveolar–arterial gradient
* hemoglobin
* oxygen–hemoglobin dissociation curve (Oxygen saturation
* 2,3-BPG
* Bohr effect
* Haldane effect)
* carbonic anhydrase (chloride shift)
* oxyhemoglobin
* respiratory quotient
* arterial blood gas
* diffusion capacity (DLCO)

Insufficiency|

* high altitude
* death zone
* oxygen toxicity
* hypoxia

* v
* t
* e

* Poisoning
* Toxicity
* Overdose

* Poison
* History

Inorganic|

| Metals|

| Toxic metals|

* Beryllium
* Cadmium
* Lead
* Mercury
* Nickel
* Thallium
* Tin

|

Dietary minerals|

* Chromium
* Cobalt
* Copper
* Iron
* Manganese
* Zinc

Other non-toxic metals|

* Silver1

Metalloids|

* Arsenic

Nonmetals|

* Sulfuric acid
* Selenium
* Chlorine
* Fluoride

Organic|

| Phosphorus|

* Pesticides
* Aluminium phosphide
* Organophosphates

|

Nitrogen|

* Cyanide
* Nicotine
* Nitrogen dioxide poisoning

CHO|

* alcohol
* Ethanol
* Ethylene glycol
* Methanol
* Carbon monoxide
* Oxygen
* Toluene

Pharmaceutical|

| Drug overdoses|

| Nervous|

* Alcohol
* Anticholinesterase
* Aspirin
* Barbiturates
* Benzodiazepines
* Cocaine
* Lithium
* Opioids
* Paracetamol
* Serotonergic substances
* Tricyclic antidepressants

|

Cardiovascular|

* Digoxin
* Dipyridamole

Vitamin poisoning|

* Vitamin A
* Vitamin D
* Vitamin E
* Megavitamin-B6 syndrome

Biological2|

| Fish / Seafood|

* Ciguatera
* Haff disease
* Ichthyoallyeinotoxism
* Scombroid
* Shellfish poisoning
* Amnesic
* Diarrhetic
* Neurotoxic
* Paralytic

|

Other vertebrates|

* Amphibian
* Batrachotoxin
* Bombesin
* Bufotenin
* Physalaemin
* Birds
* Coturnism
* Mammal
* Snakes / Snake venom
* Alpha-Bungarotoxin
* Ancrod
* Batroxobin

Arthropods|

* Arthropod bites and stings
* Bee sting / Bee venom
* Apamin
* Melittin
* Scorpion venom
* Charybdotoxin
* spider venom
* Latrotoxin / Latrodectism
* Loxoscelism
* Tick paralysis

Plants / Fungi|

* Cinchonism
* Ergotism
* Fish toxins
* Lathyrism
* Locoism
* Mushroom
* Strychnine

Related topics|

* Bite and Stinger
* plant
* Cnidocyte
* Venomous animals
* Poisonous animals
* Deadly fungus
* Mycotoxicology

Miscellaneous|

* Antibiotic
* EPA list of hazard
* Lists of poisonings
* List of types of poison
* Pollution

1Silver is generally non-toxic metal, but in large doses it can lead to argyria, which is rare.
2 including venoms, toxins, foodborne illnesses.

* Category
* Commons
* WikiProject

* v
* t
* e

Underwater diving

* Diving activities
* Diving modes
* Atmospheric pressure diving
* Freediving
* Saturation diving
* Scuba diving
* Snorkeling
* Surface oriented diving
* Surface-supplied diving
* Unmanned diving

Diving equipment

* Cleaning and disinfection of personal diving equipment
* Human factors in diving equipment design
* List of diving equipment manufacturers

| Basic equipment|

* Diving mask
* Snorkel
* Swimfin

|

Breathing gas|

* Bailout gas
* Bottom gas
* Breathing air
* Decompression gas
* Emergency gas supply
* Heliox
* Hydreliox
* Hydrox
* Nitrox
* Oxygen
* Travel gas
* Trimix

Buoyancy and
trim equipment|

* Avelo diving system
* Buoyancy compensator
* Power inflator
* Dump valve
* Variable buoyancy pressure vessel
* Diving weighting system
* Ankle weights
* Integrated weights
* Trim weights
* Weight belt

Decompression
equipment|

* Decompression buoy
* Decompression chamber
* Decompression cylinder
* Decompression trapeze
* Dive computer
* Diving bell
* Diving shot
* Diving stage
* Jersey upline
* Jonline

Diving suit|

* Atmospheric diving suit
* JIM suit
* Newtsuit
* Dry suit
* Sladen suit
* Standard diving suit
* Rash vest
* Wetsuit
* Dive skins
* Hot-water suit

Helmets
and masks|

* Anti-fog
* Diving helmet
* Free-flow helmet
* Lightweight demand helmet
* Orinasal mask
* Reclaim helmet
* Shallow water helmet
* Standard diving helmet
* Diving mask
* Band mask
* Full-face mask
* Half mask

Instrumentation|

* Bottom timer
* Depth gauge
* Dive computer
* Dive timer
* Diving watch
* Helium release valve
* Electro-galvanic oxygen sensor
* Pneumofathometer
* Submersible pressure gauge

Mobility
equipment|

* Diver propulsion vehicle
* Human torpedo
* Wet sub
* Diving bell
* Closed bell
* Wet bell
* Diving stage
* Swimfin
* Monofin
* PowerSwim
* Towboard

Safety
equipment|

* Alternative air source
* Octopus regulator
* Pony bottle
* Bolt snap
* Buddy line
* Dive light
* Diver's cutting tool
* Diver's knife
* Diver's telephone
* Through-water communications
* Underwater acoustic communication
* Diving bell
* Diving safety harness
* Emergency gas supply
* Bailout block
* Bailout bottle
* Lifeline
* Screw gate carabiner
* Emergency locator beacon
* Rescue tether
* Safety helmet
* Shark-proof cage
* Snoopy loop
* Navigation equipment
* Distance line
* Diving compass
* Dive reel
* Line marker
* Surface marker buoy
* Silt screw

Underwater
breathing
apparatus|

* Atmospheric diving suit
* Diving cylinder
* Burst disc
* Scuba cylinder valve
* Diving helmet
* Reclaim helmet
* Diving regulator
* Mechanism of diving regulators
* Regulator malfunction
* Regulator freeze
* Single-hose regulator
* Twin-hose regulator
* Full-face diving mask

| Open-circuit
scuba|

* Scuba set
* Bailout bottle
* Decompression cylinder
* Independent doubles
* Manifolded twin set
* Scuba manifold
* Pony bottle
* Scuba configuration
* Sidemount
* Sling cylinder

|

Diving rebreathers|

* Carbon dioxide scrubber
* Carleton CDBA
* Clearance Divers Life Support Equipment
* Cryogenic rebreather
* CUMA
* DSEA
* Dolphin
* Halcyon PVR-BASC
* Halcyon RB80
* IDA71
* Interspiro DCSC
* LAR-5
* LAR-6
* LAR-V
* LARU
* Mark IV Amphibian
* Porpoise
* Ray
* Siebe Gorman CDBA
* Salvus
* Siva

Surface-supplied
diving equipment|

* Air line
* Diver's umbilical
* Diving air compressor
* Gas panel
* Hookah
* Scuba replacement
* Snuba
* Standard diving dress

Diving
equipment
manufacturers|

* AP Diving
* Apeks
* Aqua Lung America
* Aqua Lung/La Spirotechnique
* Beuchat
* René Cavalero
* Cis-Lunar
* Cressi-Sub
* Dacor
* DESCO
* Dive Xtras
* Divex
* Diving Unlimited International
* Drägerwerk
* Faber
* Fenzy
* Maurice Fernez
* Technisub
* Oscar Gugen
* Heinke
* HeinrichsWeikamp
* Johnson Outdoors
* Mares
* Morse Diving
* Nemrod
* Oceanic Worldwide
* Porpoise
* Shearwater Research
* Siebe Gorman
* Submarine Products
* Suunto

Diving support equipment

| Access equipment|

* Boarding stirrup
* Diver lift
* Diving bell
* Diving ladder
* Diving platform (scuba)
* Diving stage
* Downline
* Jackstay
* Launch and recovery system
* Messenger line
* Moon pool

|

Breathing gas
handling|

* Air filtration
* Activated carbon
* Hopcalite
* Molecular sieve
* Silica gel
* Booster pump
* Carbon dioxide scrubber
* Cascade filling system
* Diver's pump
* Diving air compressor
* Diving air filter
* Water separator
* High pressure breathing air compressor
* Low pressure breathing air compressor
* Gas blending
* Gas blending for scuba diving
* Gas panel
* Gas reclaim system
* Gas storage bank
* Gas storage quad
* Gas storage tube
* Helium analyzer
* Nitrox production
* Membrane gas separation
* Pressure swing adsorption
* Oxygen analyser
* Electro-galvanic oxygen sensor
* Oxygen compatibility

Decompression
equipment|

* Air-lock
* Built-in breathing system
* Decompression tables
* Diving bell
* Bell cursor
* Closed bell
* Clump weight
* Launch and recovery system
* Wet bell
* Diving chamber
* Diving stage
* Recreational Dive Planner
* Saturation system

Platforms|

* Dive boat
* Canoe and kayak diving
* Combat rubber raiding craft
* Liveaboard
* Subskimmer
* Diving support vessel
* HMS Challenger (K07)

| Underwater
habitat|

* Aquarius Reef Base
* Continental Shelf Station Two
* Helgoland Habitat
* Scott Carpenter Space Analog Station
* SEALAB
* Tektite habitat

|

Remotely operated
underwater vehicles|

* 8A4-class ROUV
* ABISMO
* Atlantis ROV Team
* COTSBot
* CURV
* Deep Drone
* Épaulard
* Global Explorer ROV
* Goldfish-class ROUV
* Kaikō ROV
* Kaşif ROUV
* Long-Term Mine Reconnaissance System
* Mini Rover ROV
* OpenROV
* ROV KIEL 6000
* ROV PHOCA
* Scorpio ROV
* Sea Dragon-class ROV
* Seabed tractor
* Seafox drone
* SeaPerch
* SJT-class ROUV
* T1200 Trenching Unit
* VideoRay UROVs

Safety equipment|

* Diver down flag
* Diving shot
* ENOS Rescue-System
* Hyperbaric lifeboat
* Hyperbaric stretcher
* Jackstay
* Jonline
* Reserve gas supply

General|

* Diving spread
* Air spread
* Saturation spread
* Hot water system
* Sonar
* Underwater acoustic positioning system
* Underwater acoustic communication

Freediving

| Activities|

* Aquathlon
* Apnoea finswimming
* Freediving
* Haenyeo
* Pearl hunting
* Ama
* Snorkeling
* Spearfishing
* Underwater football
* Underwater hockey
* Underwater rugby
* Underwater target shooting

|

Competitions|

* Nordic Deep
* Vertical Blue
* Disciplines
* Constant weight (CWT)
* Constant weight bi-fins (CWTB)
* Constant weight without fins (CNF)
* Dynamic apnea (DYN)
* Dynamic apnea without fins (DNF)
* Free immersion (FIM)
* No-limits apnea (NLT)
* Static apnea (STA)
* Skandalopetra diving
* Variable weight apnea (VWT)
* Variable weight apnea without fins

Equipment|

* Diving mask
* Diving suit
* Hawaiian sling
* Polespear
* Snorkel (swimming)
* Speargun
* Swimfins
* Monofin
* Water polo cap

Freedivers|

* Deborah Andollo
* Simone Arrigoni
* Peppo Biscarini
* Michael Board
* Sara Campbell
* Derya Can Göçen
* Goran Čolak
* Carlos Coste
* Robert Croft
* Mandy-Rae Cruickshank
* Yasemin Dalkılıç
* Leonardo D'Imporzano
* Flavia Eberhard
* Şahika Ercümen
* Emma Farrell
* Francisco Ferreras
* Pierre Frolla
* Flavia Eberhard
* Mehgan Heaney-Grier
* Elisabeth Kristoffersen
* Andriy Yevhenovych Khvetkevych
* Loïc Leferme
* Enzo Maiorca
* Jacques Mayol
* Audrey Mestre
* Karol Meyer
* Kate Middleton
* Stéphane Mifsud
* Alexey Molchanov
* Natalia Molchanova
* Dave Mullins
* Patrick Musimu
* Guillaume Néry
* Herbert Nitsch
* Umberto Pelizzari
* Liv Philip
* Annelie Pompe
* Stig Severinsen
* Tom Sietas
* Martin Štěpánek
* Walter Steyn
* Tanya Streeter
* William Trubridge
* Devrim Cenk Ulusoy
* Fatma Uruk
* Danai Varveri
* Alessia Zecchini
* Nataliia Zharkova
* Kateryna Sadurska

Hazards|

* Barotrauma
* Drowning
* Freediving blackout
* Deep-water blackout
* Shallow-water blackout
* Hypercapnia
* Hypothermia

Historical|

* Ama
* Octopus wrestling
* Swimming at the 1900 Summer Olympics – Men's underwater swimming

Organisations|

* AIDA International
* Scuba Schools International
* Australian Underwater Federation
* British Freediving Association
* Confédération Mondiale des Activités Subaquatiques
* Fédération Française d'Études et de Sports Sous-Marins
* Performance Freediving International

Professional diving

| Occupations|

* Ama
* Commercial diver
* Commercial offshore diver
* Hazmat diver
* Divemaster
* Diving instructor
* Diving safety officer
* Diving superintendent
* Diving supervisor
* Haenyeo
* Media diver
* Police diver
* Public safety diver
* Scientific diver
* Underwater archaeologist

| Military
diving|

* Army engineer diver
* Canadian Armed Forces Divers
* Clearance diver
* Frogman
* Minentaucher
* Royal Navy ships diver
* United States military divers
* U.S. Navy diver
* U.S.Navy master diver

| Military
diving
units|

* 7th Marine Brigade
* Clearance Diving Branch (RAN)
* Commando Hubert
* Combat Divers Service (Lithuania)
* Comando Raggruppamento Subacquei e Incursori Teseo Tesei
* Decima Flottiglia MAS
* Frogman Corps (Denmark)
* Fuerzas Especiales
* Fukuryu
* GRUMEC
* Grup Gerak Khas
* Jagdkommando
* JW Formoza
* JW GROM
* JW Komandosów
* Kommando Spezialkräfte Marine
* KOPASKA
* MARCOS
* Marine Commandos
* Marinejegerkommandoen
* Marine Raider Regiment
* Minedykkerkommandoen
* Namibian Marine Corps Operational Diving Unit
* Naval Diving Unit (Singapore)
* Naval Service Diving Section
* Naval Special Operations Command
* Operational Diving Division (SA Navy)
* Royal Engineers
* Russian commando frogmen
* Sappers Divers Group
* Shayetet 13
* Special Air Service
* Special Air Service Regiment
* Special Actions Detachment
* Special Boat Service
* Special Boat Squadron (Sri Lanka)
* Special Forces Command (Turkey)
* Special Forces Group (Belgium)
* Special Operations Battalion (Croatia)
* Special Service Group (Navy)
* Special Warfare Diving and Salvage
* Tactical Divers Group
* US Marine Corps Force Reconnaissance
* US Marine Corps Reconnaissance Battalions
* US Navy SEALs
* Underwater Construction Teams
* Underwater Demolition Command
* Underwater Demolition Team
* Underwater Offence (Turkish Armed Forces)
* UNGERIN

|

Underwater
work|

* Commercial offshore diving
* Dive leader
* Diver training
* Recreational diver training
* Hazmat diving
* Hyperbaric welding
* Marine construction
* Offshore construction
* Underwater construction
* Media diving
* Pearl hunting
* Police diving
* Potable water diving
* Public safety diving
* Scientific diving
* Ships husbandry
* Sponge diving
* Submarine pipeline
* Underwater archaeology
* Archaeology of shipwrecks
* Underwater cutting and welding
* Underwater demolition
* Underwater inspection
* Nondestructive testing
* Underwater logging
* Underwater photography
* Underwater search and recovery
* Underwater searches
* Underwater videography
* Underwater survey

| Salvage diving|

* SS Egypt
* Kronan
* La Belle
* SS Laurentic
* RMS Lusitania
* Mars
* Mary Rose
* USS Monitor
* HMS Royal George
* Vasa

|

Diving
contractors|

* COMEX
* Helix Energy Solutions Group
* International Marine Contractors Association

Tools and
equipment|

* Abrasive waterjet
* Airlift
* Baited remote underwater video
* In-water surface cleaning
* Brush cart
* Cavitation cleaning
* Pressure washing
* Pigging
* Hot stab
* Lifting bag
* Remotely operated underwater vehicle
* Thermal lance
* Tremie
* Water jetting

Underwater
weapons|

* Limpet mine
* Speargun
* Hawaiian sling
* Polespear

| Underwater
firearm|

* Gyrojet
* Mk 1 Underwater Defense Gun
* Powerhead
* Underwater pistols
* Heckler & Koch P11
* SPP-1 underwater pistol
* Underwater revolvers
* AAI underwater revolver
* Underwater rifles
* ADS amphibious rifle
* APS underwater rifle
* ASM-DT amphibious rifle
* QBS-06

|

Recreational diving

* Recreational dive sites
* Index of recreational dive sites
* List of wreck diving sites
* Outline of recreational dive sites

| Specialties|

* Altitude diving
* Cave diving
* Deep diving
* Ice diving
* Muck diving
* Open-water diving
* Rebreather diving
* Sidemount diving
* Solo diving
* Technical diving
* Underwater photography
* Wreck diving

|

Diver
organisations|

* British Sub-Aqua Club (BSAC)
* Cave Divers Association of Australia (CDAA)
* Cave Diving Group (CDG)
* Comhairle Fo-Thuinn (CFT)
* Confédération Mondiale des Activités Subaquatiques (CMAS)
* Federación Española de Actividades Subacuáticas (FEDAS)
* Fédération Française d'Études et de Sports Sous-Marins (FFESSM)
* International Association for Handicapped Divers (IAHD)
* Quintana Roo Speleological Survey (QRSS)
* Woodville Karst Plain Project (WKPP)

Diving tourism
industry|

* Dive center
* Diving in Timor-Leste
* Diving in the Maldives
* Environmental impact of recreational diving
* Scuba diving tourism
* Scuba diving in the Cayman Islands
* Shark tourism
* Sinking ships for wreck diving sites
* Underwater diving in Guam

Diving events
and festivals|

* Diversnight
* Underwater Bike Race

Diving safety

* Human factors in diving equipment design
* Human factors in diving safety
* Life-support system
* Safety-critical system
* Scuba diving fatalities
* Underwater diving emergency
* Water safety
* Water surface searches

| Diving
hazards|

* List of diving hazards and precautions
* Environmental
* Current
* Delta-P
* Entanglement hazard
* Overhead
* Silt out
* Wave action
* Equipment
* Freeflow
* Use of breathing equipment in an underwater environment
* Failure of diving equipment other than breathing apparatus
* Single point of failure
* Physiological
* Cold shock response
* Decompression
* Nitrogen narcosis
* Oxygen toxicity
* Seasickness
* Uncontrolled decompression
* Diver behaviour and competence
* Lack of competence
* Overconfidence effect
* Panic
* Task loading
* Trait anxiety
* Willful violation

| Consequences|

* Barotrauma
* Decompression sickness
* Drowning
* Hypothermia
* Hypoxia
* Hypercapnia
* Hyperthermia
* Non-freezing cold injury

|

Diving
procedures|

* Ascending and descending
* Emergency ascent
* Boat diving
* Canoe and kayak diving
* Buddy diving
* buddy check
* Decompression
* Decompression practice
* Pyle stop
* Ratio decompression
* Dive briefing
* Dive log
* Dive planning
* Rule of thirds
* Scuba gas planning
* Diver communications
* Diver rescue
* Diver training
* Doing It Right
* Drift diving
* Gas blending for scuba diving
* Night diving
* Rebreather diving
* Scuba gas management
* Solo diving
* Wall diving

Risk
management|

* Checklist
* Hazard identification and risk assessment
* Hazard analysis
* Job safety analysis
* Risk assessment
* Hyperbaric evacuation and rescue
* Risk control
* Hierarchy of hazard controls
* Incident pit
* Lockout–tagout
* Permit To Work
* Redundancy
* Safety data sheet
* Situation awareness

| Diving team|

* Bellman
* Chamber operator
* Diver medical technician
* Diver's attendant
* Diving supervisor
* Diving systems technician
* Gas man
* Life support technician
* Stand-by diver

|

Equipment
safety|

* Breathing gas quality
* Testing and inspection of diving cylinders
* Hydrostatic test
* Sustained load cracking
* Diving regulator
* Breathing performance of regulators

Occupational
safety and
health|

* Association of Diving Contractors International
* International Marine Contractors Association
* Code of practice
* Contingency plan
* Diving regulations
* Emergency response plan
* Diving safety officer
* Diving superintendent
* Diving supervisor
* Operations manual
* Standard operating procedure

Diving medicine

| Diving
disorders|

* List of signs and symptoms of diving disorders
* Cramp
* Motion sickness
* Surfer's ear

| Pressure
related|

* Alternobaric vertigo
* Barostriction
* Barotrauma
* Air embolism
* Aerosinusitis
* Barodontalgia
* Dental barotrauma
* Middle ear barotrauma
* Pulmonary barotrauma
* Compression arthralgia
* Decompression illness
* Dysbarism

| Oxygen|

* Freediving blackout
* Hyperoxia
* Hypoxia
* Oxygen toxicity

|

Inert gases|

* Avascular necrosis
* Decompression sickness
* Dysbaric osteonecrosis
* Inner ear decompression sickness
* Isobaric counterdiffusion
* Taravana
* High-pressure nervous syndrome
* Hydrogen narcosis
* Nitrogen narcosis

Carbon dioxide|

* Hypercapnia
* Hypocapnia

Breathing gas
contaminants|

* Carbon monoxide poisoning

Immersion
related|

* Asphyxia
* Drowning
* Hypothermia
* Immersion diuresis
* Instinctive drowning response
* Laryngospasm
* Salt water aspiration syndrome
* Swimming-induced pulmonary edema

Treatment|

* Demand valve oxygen therapy
* First aid
* Hyperbaric medicine
* Hyperbaric treatment schedules
* In-water recompression
* Oxygen therapy
* Therapeutic recompression

Personnel|

* Diving Medical Examiner
* Diving Medical Practitioner
* Diving Medical Technician
* Hyperbaric nursing

Screening|

* Atrial septal defect
* Effects of drugs on fitness to dive
* Fitness to dive
* Psychological fitness to dive

Research|

| Researchers in
diving physiology
and medicine|

* Arthur J. Bachrach
* Albert R. Behnke
* Peter B. Bennett
* Paul Bert
* George F. Bond
* Robert Boyle
* Alf O. Brubakk
* Albert A. Bühlmann
* John R. Clarke
* Guybon Chesney Castell Damant
* Kenneth William Donald
* William Paul Fife
* John Scott Haldane
* Robert William Hamilton Jr.
* Henry Valence Hempleman
* Leonard Erskine Hill
* Brian Andrew Hills
* Felix Hoppe-Seyler
* Christian J. Lambertsen
* Simon Mitchell
* Charles Momsen
* Neal W. Pollock
* John Rawlins
* Charles Wesley Shilling
* Edward D. Thalmann
* Jacques Triger

|

Diving medical
research
organisations|

* Aerospace Medical Association
* Divers Alert Network (DAN)
* Diving Diseases Research Centre (DDRC)
* Diving Medical Advisory Council (DMAC)
* European Diving Technology Committee (EDTC)
* European Underwater and Baromedical Society (EUBS)
* National Board of Diving and Hyperbaric Medical Technology
* Naval Submarine Medical Research Laboratory
* Royal Australian Navy School of Underwater Medicine
* Rubicon Foundation
* South Pacific Underwater Medicine Society (SPUMS)
* Southern African Underwater and Hyperbaric Medical Association (SAUHMA)
* Undersea and Hyperbaric Medical Society (UHMS)
* United States Navy Experimental Diving Unit (NEDU)

Law

* Civil liability in recreational diving
* Diving regulations
* Duty of care
* List of legislation regulating underwater diving
* Investigation of diving accidents
* Convention on the Protection of the Underwater Cultural Heritage

History of underwater diving

* History of decompression research and development
* History of dive computers
* History of Diving Museum
* History of scuba diving
* List of researchers in underwater diving
* Lyons Maritime Museum
* Man in the Sea Museum
* Timeline of atmospheric diving suits
* Timeline of diving technology
* Pearling in Western Australia
* US Navy decompression models and tables

| Archeological
sites|

* SS Commodore
* USS Monitor
* Queen Anne's Revenge
* Whydah Gally

|

Underwater art
and artists|

* The Diver
* Jason deCaires Taylor

Engineers
and inventors|

* Jerónimo de Ayanz y Beaumont
* William Beebe
* Georges Beuchat
* Giovanni Alfonso Borelli
* Joseph-Martin Cabirol
* John R. Clarke
* Jacques Cousteau
* Charles Anthony Deane
* John Deane
* Louis de Corlieu
* Auguste Denayrouze
* Ted Eldred
* Henry Fleuss
* Émile Gagnan
* Karl Heinrich Klingert
* Peter Kreeft
* Christian J. Lambertsen
* Yves Le Prieur
* John Lethbridge
* Ernest William Moir
* Joseph Salim Peress
* Auguste Piccard
* Joe Savoie
* Willard Franklyn Searle
* Gordon Smith
* Augustus Siebe
* Pierre-Marie Touboulic
* Jacques Triger

Historical
equipment|

* Aqua-Lung
* RV Calypso
* SP-350 Denise
* Magnesium torch
* Nikonos
* Porpoise regulator
* Standard diving dress
* Sub Marine Explorer
* Vintage scuba

| Diver
propulsion
vehicles|

* Advanced SEAL Delivery System
* Cosmos CE2F series
* Dry Combat Submersible
* Human torpedo
* Motorised Submersible Canoe
* Necker Nymph
* R-2 Mala-class swimmer delivery vehicle
* SEAL Delivery Vehicle
* Shallow Water Combat Submersible
* Siluro San Bartolomeo
* Welfreighter
* Wet Nellie

|

Military and
covert operations|

* Raid on Alexandria (1941)
* Sinking of the Rainbow Warrior

Scientific projects|

* 1992 cageless shark-diving expedition
* Mission 31

Awards and events|

* Hans Hass Award
* International Scuba Diving Hall of Fame
* London Diving Chamber Dive Lectures
* NOGI Awards
* Women Divers Hall of Fame

Incidents|

| Dive boat incidents|

* Sinking of MV Conception

|

Diver rescues|

* Alpazat cave rescue
* Tham Luang cave rescue

Early diving|

* John Day (carpenter)
* Charles Spalding
* Ebenezer Watson

Freediving fatalities|

* Stephen Keenan
* Loïc Leferme
* Audrey Mestre
* Nicholas Mevoli
* Natalia Molchanova

Offshore
diving incidents|

* Byford Dolphin diving bell accident
* Drill Master diving accident
* Star Canopus diving accident
* Stena Seaspread diving accident
* Venture One diving accident
* Waage Drill II diving accident
* Wildrake diving accident

Professional
diving fatalities|

* Roger Baldwin
* John Bennett
* Victor F. Guiel Jr.
* Francis P. Hammerberg
* Craig M. Hoffman
* Peter Henry Michael Holmes
* Johnson Sea Link accident
* Edwin Clayton Link
* Gerard Anthony Prangley
* Per Skipnes
* Robert John Smyth
* Albert D. Stover
* Richard A. Walker
* Lothar Michael Ward
* Joachim Wendler
* Bradley Westell
* Arne Zetterström

Scuba diving
fatalities|

* 1973 Mount Gambier cave diving accident
* Ricardo Armbruster
* Allan Bridge
* David Bright
* Berry L. Cannon
* Cotton Coulson
* Cláudio Coutinho
* E. Yale Dawson
* Deon Dreyer
* Milan Dufek
* Sheck Exley
* Maurice Fargues
* Fernando Garfella Palmer
* Guy Garman
* Steve Irwin
* death
* Jim Jones
* Henry Way Kendall
* Artur Kozłowski
* Yuri Lipski
* Kirsty MacColl
* Linnea Mills
* Agnes Milowka
* François de Roubaix
* Chris and Chrissy Rouse
* Dave Shaw
* Wesley C. Skiles
* Dewey Smith
* Rob Stewart
* Esbjörn Svensson
* Josef Velek

Publications

| Manuals|

* NOAA Diving Manual
* U.S. Navy Diving Manual
* Basic Cave Diving: A Blueprint for Survival
* Underwater Handbook
* Bennett and Elliott's physiology and medicine of diving
* Encyclopedia of Recreational Diving
* The new science of skin and scuba diving
* Professional Diver's Handbook
* Basic Scuba

|

Standards and
Codes of Practice|

* Code of Practice for Scientific Diving (UNESCO)
* DIN 7876
* IMCA Code of Practice for Offshore Diving
* ISO 24801 Recreational diving services — Requirements for the training of recreational scuba divers

General non-fiction|

* The Darkness Beckons
* Goldfinder
* The Last Dive
* Shadow Divers
* The Silent World: A Story of Undersea Discovery and Adventure

Research|

* List of Divers Alert Network publications

Dive guides|

Training and registration

| Diver
training|

* Competence and assessment
* Competency-based learning
* Refresher training
* Skill assessment
* Diver training standard
* Diving instructor
* Diving school
* Occupational diver training
* Commercial diver training
* Military diver training
* Public safety diver training
* Scientific diver training
* Recreational diver training
* Introductory diving
* ISO training standards
* Teaching method
* Muscle memory
* Overlearning
* Stress exposure training

| Skills|

* Combat sidestroke
* Diver navigation
* Diver trim
* Ear clearing
* Frenzel maneuver
* Valsalva maneuver
* Finning techniques
* Scuba skills
* Buddy breathing
* Low impact diving
* Diamond Reef System
* Surface-supplied diving skills
* Underwater searches

|

Recreational
scuba
certification
levels|

| Core diving skills|

* Advanced Open Water Diver
* Autonomous diver
* CMAS* scuba diver
* CMAS** scuba diver
* Introductory diving
* Low Impact Diver
* Master Scuba Diver
* Open Water Diver
* Supervised diver

|

Leadership skills|

* Dive leader
* Divemaster
* Diving instructor
* Master Instructor

Specialist skills|

* Rescue Diver
* Solo diver

Diver training
certification
and registration
organisations|

* European Underwater Federation (EUF)
* International Diving Regulators and Certifiers Forum (IDRCF)
* International Diving Schools Association (IDSA)
* International Marine Contractors Association (IMCA)
* List of diver certification organizations
* National Oceanic and Atmospheric Administration (NOAA)
* Nautical Archaeology Society
* Recreational diver course referral
* World Recreational Scuba Training Council (WRSTC)

| Commercial diver
certification
authorities|

* Australian Diver Accreditation Scheme (ADAS)
* Commercial diver registration in South Africa
* Divers Institute of Technology
* Health and Safety Executive (HSE)
* Department of Employment and Labour

|

Commercial diving
schools|

* Divers Academy International
* Norwegian diver school

Free-diving
certification
agencies|

* AIDA International (AIDA)
* Confédération Mondiale des Activités Subaquatiques (CMAS)
* Performance Freediving International (PI)
* Scuba Schools International (SSI)

Recreational
scuba
certification
agencies|

* American Canadian Underwater Certifications (ACUC)
* American Nitrox Divers International (ANDI)
* Association nationale des moniteurs de plongée (ANMP)
* British Sub-Aqua Club (BSAC)
* Comhairle Fo-Thuinn (CFT)
* Confédération Mondiale des Activités Subaquatiques (CMAS)
* Federación Española de Actividades Subacuáticas (FEDAS)
* Fédération Française d'Études et de Sports Sous-Marins (FFESSM)
* Federazione Italiana Attività Subacquee (FIAS)
* Global Underwater Explorers (GUE)
* International Association for Handicapped Divers (IAHD)
* International Association of Nitrox and Technical Divers (IANTD)
* International Life Saving Federation (ILS)
* Israeli Diving Federation (TIDF)
* National Academy of Scuba Educators (NASE)
* National Association of Underwater Instructors (NAUI)
* Nederlandse Onderwatersport Bond (NOB)
* Professional Association of Diving Instructors (PADI)
* Professional Diving Instructors Corporation (PDIC)
* Professional Technical and Recreational Diving (ProTec)
* Rebreather Association of International Divers (RAID)
* Sub-Aqua Association (SAA)
* Scuba Diving International (SDI)
* Scuba Educators International (SEI)
* Scuba Schools International (SSI)
* Türkiye Sualtı Sporları Federasyonu (TSSF)
* United Diving Instructors (UDI)
* YMCA SCUBA Program

Scientific diver
certification
authorities|

* American Academy of Underwater Sciences (AAUS)
* CMAS Scientific Committee

Technical diver
certification
agencies|

* American Nitrox Divers International (ANDI)
* British Sub-Aqua Club (BSAC)
* Confédération Mondiale des Activités Subaquatiques (CMAS)
* Diving Science and Technology (DSAT)
* Federazione Italiana Attività Subacquee (FIAS)
* International Association of Nitrox and Technical Divers (IANTD)
* Professional Association of Diving Instructors (PADI)
* Professional Diving Instructors Corporation (PDIC)
* Professional Technical and Recreational Diving (ProTec)
* Rebreather Association of International Divers (RAID)
* Trimix Scuba Association (TSA)
* Technical Extended Range (TXR)

| Cave
diving|

* Cave Divers Association of Australia (CDAA)
* Cave Diving Group (CDG)
* Global Underwater Explorers (GUE)
* National Speleological Society#Cave Diving Group (CDG)
* National Association of Underwater Instructors (NAUI)
* Technical Diving International (TDI)

|

Military diver
training centres|

* Defence Diving School
* Navy Diving Salvage and Training Center
* Underwater Escape Training Unit

Military diver
training courses|

* United States Marine Corps Combatant Diver Course

Underwater sports

| Surface snorkeling|

* Finswimming

|

Snorkeling/breath-hold|

* Spearfishing
* Underwater football
* Underwater hockey
* Australia
* Turkey
* Underwater rugby
* Colombia
* United States
* Underwater target shooting

Breath-hold|

* Aquathlon
* Apnoea finswimming
* Freediving

Open Circuit Scuba|

* Immersion finswimming
* Sport diving
* Underwater cycling
* Underwater orienteering
* Underwater photography

Rebreather|

* Underwater photography

Sports governing
organisations
and federations|

* International
* AIDA International
* Confédération Mondiale des Activités Subaquatiques)
* National
* AIDA Hellas
* Australian Underwater Federation
* British Freediving Association
* British Octopush Association
* British Underwater Sports Association
* Comhairle Fo-Thuinn
* Federación Española de Actividades Subacuáticas
* Fédération Française d'Études et de Sports Sous-Marins
* South African Underwater Sports Federation
* Türkiye Sualtı Sporları Federasyonu
* Underwater Society of America)

Competitions|

* 14th CMAS Underwater Photography World Championship
* Underwater Hockey World Championships
* Underwater Orienteering World Championships
* Underwater Rugby World Championships

Underwater divers

| Pioneers
of diving|

* Eduard Admetlla i Lázaro
* Aquanaut
* Mary Bonnin
* Amelia Behrens-Furniss
* James F. Cahill
* Jacques Cousteau
* Billy Deans
* Dottie Frazier
* Trevor Hampton
* Hans Hass
* Hannes Keller
* Dick Rutkowski
* Teseo Tesei
* Arne Zetterström

|

Underwater
scientists
archaeologists and
environmentalists|

* Michael Arbuthnot
* Robert Ballard
* George Bass
* Mensun Bound
* Louis Boutan
* Jeffrey Bozanic
* Hugh Bradner
* Cathy Church
* Eugenie Clark
* James P. Delgado
* Sylvia Earle
* John Christopher Fine
* George R. Fischer
* Anders Franzén
* Honor Frost
* Fernando Garfella Palmer
* David Gibbins
* Graham Jessop
* Swietenia Puspa Lestari
* Pilar Luna
* Robert F. Marx
* Anna Marguerite McCann
* Innes McCartney
* Charles T. Meide
* Mark M. Newell
* Lyuba Ognenova-Marinova
* John Peter Oleson
* Mendel L. Peterson
* Richard Pyle
* Andreas Rechnitzer
* William R. Royal
* Margaret Rule
* Gunter Schöbel
* Stephanie Schwabe
* Myriam Seco
* E. Lee Spence
* Robert Sténuit
* Peter Throckmorton
* Cristina Zenato

Scuba record
holders|

* Pascal Bernabé
* Jim Bowden
* Mark Ellyatt
* Sheck Exley
* Nuno Gomes
* Claudia Serpieri
* Krzysztof Starnawski

Underwater
filmmakers
and presenters|

* Samir Alhafith
* David Attenborough
* Ramón Bravo
* Jean-Michel Cousteau
* Richie Kohler
* Paul Rose
* Andy Torbet
* Ivan Tors
* Andrew Wight
* James Cameron

Underwater
photographers|

* Doug Allan
* Tamara Benitez
* Georges Beuchat
* Adrian Biddle
* Jonathan Bird
* Eric Cheng
* Neville Coleman
* Jacques Cousteau
* John D. Craig
* Ben Cropp
* Bernard Delemotte
* David Doubilet
* Candice Farmer
* John Christopher Fine
* Rodney Fox
* Ric Frazier
* Stephen Frink
* Peter Gimbel
* Monty Halls
* Hans Hass
* Henry Way Kendall
* Rudie Kuiter
* Joseph B. MacInnis
* Luis Marden
* Agnes Milowka
* Noel Monkman
* Pete Oxford
* Steve Parish
* Zale Parry
* Pierre Petit
* Leni Riefenstahl
* Peter Scoones
* Brian Skerry
* Wesley C. Skiles
* E. Lee Spence
* Philippe Tailliez
* Ron Taylor
* Valerie Taylor
* Albert Tillman
* John Veltri
* Stan Waterman
* Michele Westmorland
* John Ernest Williamson
* J. Lamar Worzel

Underwater
explorers|

* Caves
* Graham Balcombe
* Sheck Exley
* Martyn Farr
* Jochen Hasenmayer
* Jill Heinerth
* Jarrod Jablonski
* Brian Kakuk
* William Hogarth Main
* Tom Mount
* Jack Sheppard
* Bill Stone
* Reefs
* Arthur C. Clarke
* Wrecks
* Leigh Bishop
* John Chatterton
* Clive Cussler
* Bill Nagle
* Valerie van Heest
* Aristotelis Zervoudis

Aquanauts|

* Andrew Abercromby
* Joseph M. Acaba
* Clayton Anderson
* Richard R. Arnold
* Serena Auñón-Chancellor
* Michael Barratt (astronaut)
* Robert A. Barth
* Robert L. Behnken
* Randolph Bresnik
* Timothy J. Broderick
* Justin Brown
* Berry L. Cannon
* Scott Carpenter
* Gregory Chamitoff
* Steve Chappell
* Catherine Coleman
* Robin Cook
* Craig B. Cooper
* Fabien Cousteau
* Philippe Cousteau
* Timothy Creamer
* Jonathan Dory
* Pedro Duque
* Sylvia Earle
* Jeanette Epps
* Sheck Exley
* Albert Falco
* Andrew J. Feustel
* Michael Fincke
* Satoshi Furukawa
* Ronald J. Garan Jr.
* Michael L. Gernhardt
* Christopher E. Gerty
* David Gruber
* Chris Hadfield
* Jeremy Hansen
* José M. Hernández
* John Herrington
* Paul Hill
* Akihiko Hoshide
* Mark Hulsbeck
* Emma Hwang
* Norishige Kanai
* Les Kaufman
* Scott Kelly
* Karen Kohanowich
* Timothy Kopra
* Dominic Landucci
* Jon Lindbergh
* Kjell N. Lindgren
* Michael López-Alegría
* Joseph B. MacInnis
* Sandra Magnus
* Thomas Marshburn
* Matthias Maurer
* K. Megan McArthur
* Craig McKinley
* Jessica Meir
* Simone Melchior
* Dorothy Metcalf-Lindenburger
* Andreas Mogensen
* Karen Nyberg
* John D. Olivas
* Takuya Onishi
* Luca Parmitano
* Nicholas Patrick
* Tim Peake
* Thomas Pesquet
* Marc Reagan
* Garrett Reisman
* Kathleen Rubins
* Dick Rutkowski
* Tara Ruttley
* David Saint-Jacques
* Josef Schmid
* Robert Sheats
* Dewey Smith
* Steve Squyres
* Heidemarie Stefanyshyn-Piper
* Robert Sténuit
* Hervé Stevenin
* Nicole Stott
* James Talacek
* Daniel M. Tani
* Robert Thirsk
* Bill Todd
* Mark T. Vande Hei
* Koichi Wakata
* Rex J. Walheim
* Shannon Walker
* John Morgan Wells
* Joachim Wendler
* Douglas H. Wheelock
* Peggy Whitson
* Dafydd Williams
* Jeffrey Williams
* Sunita Williams
* Reid Wiseman
* Kimiya Yui

Writers and journalists|

* Michael C. Barnette
* Victor Berge
* Philippe Diolé
* Gary Gentile
* Bret Gilliam
* Bob Halstead
* Hillary Hauser
* Trevor Jackson
* Steve Lewis
* John Mattera

Rescuers|

* Craig Challen
* Richard Harris
* Rick Stanton
* John Volanthen

Frogmen|

* Lionel Crabb
* Ian Edward Fraser
* Sydney Knowles
* James Joseph Magennis

Commercial salvors|

* Keith Jessop

Science of underwater diving

* List of researchers in underwater diving

| Diving
physics|

* Metre sea water
* Neutral buoyancy
* Underwater acoustics
* Modulated ultrasound
* Underwater vision
* Underwater computer vision

|

Diving
physiology|

* Blood shift
* Cold shock response
* Diving reflex
* Equivalent narcotic depth
* Maximum operating depth
* Physiological response to water immersion
* Thermal balance of the underwater diver
* Underwater vision
* Work of breathing

| Decompression
theory|

* Decompression models:
* Bühlmann decompression algorithm
* Haldane's decompression model
* Reduced gradient bubble model
* Thalmann algorithm
* Thermodynamic model of decompression
* Varying Permeability Model
* Equivalent air depth
* Oxygen window
* Physiology of decompression

|

Diving
environments|

* Underwater exploration
* Deep-sea exploration

| Classification|

* List of diving environments by type
* Altitude diving
* Benign water diving
* Confined water diving
* Deep diving
* Inland diving
* Inshore diving
* Muck diving
* Night diving
* Open-water diving
* Black-water diving
* Blue-water diving
* Penetration diving
* Cave diving
* Torricellian chamber
* Ice diving
* Wreck diving
* Recreational dive sites
* Underwater environment
* Underwater diving environment

|

Impact|

* Environmental impact of recreational diving
* Low impact diving

Other

* Bathysphere
* Defense against swimmer incursions
* Diver detection sonar
* Offshore survey
* Rugged compact camera
* Underwater domain awareness
* Underwater vehicle

| Deep-submergence
vehicle|

* Aluminaut
* DSV Alvin
* American submarine NR-1
* Bathyscaphe
* Archimède
* FNRS-2
* FNRS-3
* Harmony class bathyscaphe
* Sea Pole-class bathyscaphe
* Trieste II
* Deepsea Challenger
* Ictineu 3
* JAGO
* Jiaolong
* Konsul-class submersible
* Limiting Factor
* Russian submarine Losharik
* Mir
* Nautile
* Pisces-class deep submergence vehicle
* DSV Sea Cliff
* DSV Shinkai
* DSV Shinkai 2000
* DSV Shinkai 6500
* DSV Turtle
* DSV-5 Nemo

|

Submarine rescue|

* International Submarine Escape and Rescue Liaison Office
* Submarine Escape and Rescue system (Royal Swedish Navy)
* McCann Rescue Chamber
* Submarine rescue ship

| Deep-submergence
rescue vehicle|

* LR5
* LR7
* MSM-1
* Mystic-class deep-submergence rescue vehicle
* DSRV-1 Mystic
* DSRV-2 Avalon
* NATO Submarine Rescue System
* Priz-class deep-submergence rescue vehicle
* Russian deep submergence rescue vehicle AS-28
* Russian submarine AS-34
* ASRV Remora
* SRV-300
* Submarine Rescue Diving Recompression System
* Type 7103 DSRV
* URF (Swedish Navy)

|

Submarine escape|

* Escape trunk
* Submarine escape training facility
* Submarine Escape Training Facility (Australia)

| Escape set|

* Davis Submerged Escape Apparatus
* Momsen lung
* Steinke hood
* Submarine Escape Immersion Equipment

|

Special
interest
groups|

* Artificial Reef Society of British Columbia
* CMAS Europe
* Coral Reef Alliance
* Divers Alert Network
* Green Fins
* Finger Lakes Underwater Preserve Association
* Karst Underwater Research
* Nautical Archaeology Program
* Nautical Archaeology Society
* Naval Air Command Sub Aqua Club
* PADI AWARE
* Reef Check
* Reef Life Survey
* Rubicon Foundation
* Save Ontario Shipwrecks
* SeaKeys
* Sea Research Society
* Society for Underwater Historical Research
* Society for Underwater Technology
* Underwater Archaeology Branch, Naval History & Heritage Command

Neutral buoyancy
facilities for
Astronaut training|

* Neutral Buoyancy Laboratory
* Neutral buoyancy pool
* Neutral buoyancy simulation as a training aid
* Neutral Buoyancy Simulator
* Space Systems Laboratory
* Yuri Gagarin Cosmonaut Training Center

Other|

* Nautilus Productions
* Helicopter Aircrew Breathing Device
* Scuba diving therapy
* Seabed mining

* Category
* Commons
* Glossary
* Indexes: Dive sites
* Divers
* Diving
* Outline
* Portal

Portal:

* Medicine

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