Principles, concepts, and perspectives for the improvement of decompression procedures: a Neo-Haldanian approach bridging bubble physics and decompression physiology.
5 affiliations
- 1Environmental and Occupational, Physiology Laboratory, Haute Ecole Bruxelles-Brabant (HE2B), Brussels, Belgium.
- 2The Israel Naval Medical Institute, Haifa, Israel.
- 3Eliachar Research Laboratory, Western Galilee Medical Center, Nahariya, Israel.
- 4Europe Research Division, Divers Alert Network (DAN), Brussels, Belgium.
- 5Europe Research Division, Divers Alert Network (DAN), Roseto, Italy.
Abstract
Introduction
This paper is a narrative review and theoretical perspective presenting principles, concepts, and perspectives for improving decompression procedures. It distinguishes three levels of evidence: established observations, hypotheses with experimental support, and mechanistic scenarios that remain hypothetical.Methods
We organize decompression around two linked dimensions: bubbles as the primary physical event and microparticles (MPs) as a physiological consequence. We hypothesize that a substantial proportion of decompression-related microbubbles originate from pre-existing gas micronuclei associated with active hydrophobic sites (AHS) at three locations: distal arterial, venous, and extravascular. From these assumptions, five bubble scenarios are considered: growth and detachment from distal arterial AHS; growth and detachment from venous AHS; pulmonary bubble filtration; survival of arterial gas microbubbles and their potential target organs; and intravascular bubble development. Physiological factors may generate MPs, endothelial dysfunction, systemic inflammation, and possibly a secondary generation of microbubbles.Results and discussion
The proposed scenarios align with decompression sickness (DCS) pathophysiology across five target organ systems: skin, brain, inner ear, spinal cord, and musculoskeletal tissue. Inflammatory stress appears important for defining post-dive intervals and multiday diving patterns. Designing decompression procedures therefore requires integrating individual variability and dive history; dive characteristics such as rapid ascents, yo-yo diving, and surface decompression; the bubble scenarios triggered during ascent; and accumulated oxidative stress, oxy-inflammation, and endothelial damage that modify susceptibility to DCS.Conclusion
There is no single ultimate decompression algorithm; rather, different strategies reflect different experience, assumptions, and operational contexts.
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BibTeX
@article{imbert2026principles,
title = {{Principles, concepts, and perspectives for the improvement of decompression procedures: a Neo-Haldanian approach bridging bubble physics and decompression physiology.}},
author = {Jean-Pierre Imbert and Ran Arieli and Costantino Balestra},
journal = {Frontiers in physiology},
year = {2026},
month = oct,
doi = {10.3389/fphys.2026.1943519},
url = {https://europepmc.org/article/MED/42909981},
note = {CC BY},
}
RIS
TY - JOUR
TI - Principles, concepts, and perspectives for the improvement of decompression procedures: a Neo-Haldanian approach bridging bubble physics and decompression physiology.
AU - Jean-Pierre Imbert
AU - Ran Arieli
AU - Costantino Balestra
PY - 2026
DA - 2026/10/07
JO - Frontiers in physiology
DO - 10.3389/fphys.2026.1943519
UR - https://europepmc.org/article/MED/42909981
AB - Introduction This paper is a narrative review and theoretical perspective presenting principles, concepts, and perspectives for improving decompression procedures. It distinguishes three levels of evidence: established observations, hypotheses with experimental support, and mechanistic scenarios that remain hypothetical.Methods We organize decompression around two linked dimensions: bubbles as the primary physical event and microparticles (MPs) as a physiological consequence. We hypothesize that a substantial proportion of decompression-related microbubbles originate from pre-existing gas micronuclei associated with active hydrophobic sites (AHS) at three locations: distal arterial, venous, and extravascular. From these assumptions, five bubble scenarios are considered: growth and detachment from distal arterial AHS; growth and detachment from venous AHS; pulmonary bubble filtration; survival of arterial gas microbubbles and their potential target organs; and intravascular bubble development. Physiological factors may generate MPs, endothelial dysfunction, systemic inflammation, and possibly a secondary generation of microbubbles.Results and discussion The proposed scenarios align with decompression sickness (DCS) pathophysiology across five target organ systems: skin, brain, inner ear, spinal cord, and musculoskeletal tissue. Inflammatory stress appears important for defining post-dive intervals and multiday diving patterns. Designing decompression procedures therefore requires integrating individual variability and dive history; dive characteristics such as rapid ascents, yo-yo diving, and surface decompression; the bubble scenarios triggered during ascent; and accumulated oxidative stress, oxy-inflammation, and endothelial damage that modify susceptibility to DCS.Conclusion There is no single ultimate decompression algorithm; rather, different strategies reflect different experience, assumptions, and operational contexts.
SN - 1664-042X
ER -