In other posts on this blog, we have discussed Point-of-care ultrasound (POCUS) and the benefits that it provides for patients and physicians. In a recent lecture, I argued that POCUS increases the value of care that we provide to our patients. This is, in part, driven by the fact that POCUS allows us to have a better window into the human body than our eyes, hands and ears can otherwise provide. One of the other unique features of POCUS that allows it to be a valuable tool in the hands of medical providers is its portability. Laptop style machines and now handheld machines allows ultrasound to be used to assess patients in environments ranging from the battlefield to outer space.
This particular study caught my eye, because it was yet another creative example of performing POCUS in a non-typical location - underwater. The authors began the paper by discussing the various physiologic changes that occur underwater and the cardiopulmonary complications of diving. While much is known through previous studies, ultrasound has the potential to explain more and be a means of monitoring swimmers during their dive and ascent.
In this study, the authors wanted to test the feasibility of an ultrasound machine containment apparatus at the depth of 42 meters. To be useable, the ultrasound machine needed to be contained in a pressure regulated enclosure that had a clear cover and a gloved port for machine manipulation. Since water pressure increases approximately 1 ATA (absolute atmosphere) every 10 meters, the system needed to be able to withstand and pressure regulate up to 5.2 ATA. Thus, they created a gas inlet/outlet system to accomplish this regulation.
The dive trials took place at Y-40 The Deep Joy Pool in Padova, Italy. After some initial troubleshooting in pilot dives while empty, the authors were able to successfully dive the apparatus with an ultrasound machine and perform lung ultrasound at depths of 15 and 42 meters. Each dive was approximately 1 hour in duration which included dive, scanning, and ascent.
I find this study fascinating - mostly because of the profoundly unique environment and the potential for interesting new applications of POCUS. The authors did not discuss any technical aspects of performing the ultrasound in this paper. So, I look forward to future papers that evaluate the physiologic findings of ultrasound performed at depth.
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