NOBENDEM. Advanced Decompression Tables

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NOBENDEM Advanced Decompression Tables Benton Zwart, COL, USAF, MC, CFS Chief, Clinical Hyperbaric Medicine Davis Hyperbaric Laboratory Brooks AFB, Texas

Outline A Colorful History of Nitrogen Bubbles Haldanes Theory Decompression Table Theory Tweaks Nobendem Model Repet Dives - Some Insights Nobendem Calculator Examples

Blame Henry! Boyle saw Bubbles in Pet Viper (1670) 1840 s - Caisson Workers Illness 1889 Moir s Hudson River Recompression Annual mortality decreases from 25% to 1.6% Bert Decides Bubbles are Nitrogen (1878) Henry s Law of Solubilities Haldanes 2:1 Supersaturation Theory

Tissue Compartments Independent From Each Other Absorb and Release Nitrogen Exponential Model N(t) = N 0 + (N f - N 0 )*(1 - e -.693*t/k ) Characteristic = Half-Time (t 1/2 )

Exponential Model 64 56 48 Nitrogen Level 40 32 24 16 8 0 0 10 20 30 40 50 60 70 80 Minutes

The US Navy Model Diving At Sea Level Assumptions Barometric Pressure = 760 Torr Linear Supersaturation Model Deepest Segment First Staged Decompression Ascent at 30 FPM Methods Only 6 Tissue Compartments 5, 10, 20, 40, 80, 120 Minutes Look-up Tables

Staged Decompression 300 5 Minute Tissue Ms(d) 250 200 150 Supersaturation Model?? 100 50 1:1 Ratio 0-35 -25-15 -5 5 15 25 35 45 55 65 Depth in FSW relative to sea level

TWEAKS Standard Table Mods making them Safer Add 10 FSW to Max Depth Add 5 Min to bottom time Dive air tables on 28% O2 Nitrox Round shallower on Repet group determination Deco at or shallower than 40 FSW on 100% O2 Unscientific, Uncalibrated Usable in a pinch Do afford increased margin of safety

The Nobendem Model Unrestricted Diving Assumptions Barometric Pressure = Variable Specify Your Nitrox Mix (21% Default = Air) Non-Linear Supersaturation Model Depth Profile As Desired Staged Decompression (You Decide Where) Ascent at Any Desired Rate (30 FPM Nominal) Methods 10 Tissue Compartments 5, 10, 20, 40, 80, 120, 160, 320, 480, 640 Minutes Real-Time Spreadsheet Calculator

Tissue Compartment Ms(d) Depth-specific Critical Values For Various Tissue Compartments T1/2 5 10 20 40 80 120 160 320 480 640 Ms(d) Ms(0) 104.00 88.00 72.00 58.00 52.00 51.00 48.50 47.40 46.90 46.40 Ms(10) 126.00 107.00 90.00 72.00 65.00 64.00 61.43 60.12 59.48 58.90 Ms(20) 150.00 128.00 106.00 87.00 78.00 76.00 73.36 71.87 71.09 70.44 Ms(30) 174.00 148.00 124.00 99.00 90.00 88.00 85.29 83.61 82.69 81.99 Ms(40) 195.00 167.00 141.00 113.00 103.00 101.00 98.22 96.33 95.27 94.49 Ms(50) 220.00 189.00 158.00 128.00 115.00 114.00 111.15 109.06 107.85 106.99 Ms(60) 242.00 208.00 174.00 141.00 128.00 126.00 123.08 120.80 119.46 118.53 Ms(70) 263.00 228.00 192.00 156.00 142.00 140.00 137.00 134.50 133.00 132.00

Diving at Altitude The BIG Problem! The Double Pressure Dilemma Depth Altitude Versus Double-Pressure Depth 35 30 25 20 15 10 5 0 0 5000 10000 15000 20000 Altitude

Nobendem Safety Enhancement 300 250 Ms(d) 200 150 100 50 Ms(d) for 0 and 100 Safety Factors For 5 Min Tissue 0-35 -25-15 -5 5 15 25 35 45 55 65 Depth in FSW relative to sea level

Transition Compensation Nitrogen Modeling During Ascent & Descent Must account for varying pn2 due to: Depth Change Gas Mix Change Linear Decomposition To Sum of 2 Exponentials Derate Component Due To Depth Change Assume Linear Transition Compare to Tissue Compartment Half-Time

Transition Model Ramp and Step Functions 6 5 4 3 2 1 0 Ramp Step 0 1 2 3 4 5 6 F(t-½, dt) = (0.5 + 0.5*dt /(t-½ + dt))

The Nobendem Solution -0.693147181 30 N 2 Tissue Compartments Copyright (C) 1998 Benton P. Zwart 5 10 20 40 80 120 160 320 480 640 T1/2 Initial Tissue PN 2 19.24 2.2990 2.0083 1.7060 1.3905 1.2726 1.2619 1.2548 1.2350 1.2208 1.2137 Slope Safety Enhancement (0-100) 0 103.60 87.58 72.42 58.08 52.08 50.83 48.33 47.24 46.74 46.24 Intercept Local Barometer (mmhg) 561 2.2990 2.0083 1.7060 1.3905 1.2726 1.2619 1.2548 1.2350 1.2208 1.2137 Safety Slope Initial Steady State FiO2 0.21 103.60 87.58 72.42 58.08 52.08 50.83 48.33 47.24 46.74 46.24 Safety Intercept Depth Gauge Must = 0 at Surface of Water! Linear Transition Time 0.00 2.3 19.24 19.24 19.24 19.24 19.24 19.24 19.24 19.24 19.24 19.24 PN 2 (t) Transition O 2 Fraction 0.21 Calculated Target PN 2 66.64 221.67 190.72 160.04 129.49 117.44 115.64 112.78 110.67 109.44 108.57 Nxt Seg Ms Initial PN 2 Inspired 19.24 221.67 190.72 160.04 129.49 117.44 115.64 112.78 110.67 109.44 108.57 Safety Ms Target - Initial 47.4 202.43 171.48 140.79 110.25 98.20 96.40 93.53 91.42 90.20 89.33 Buffer Segment 1 Conditions Segment Depth (FSW) 60 66.36 63.00 53.50 41.68 32.24 28.37 26.26 22.89 21.71 21.11 PN 2 (t) Segment Time (Min) 37 76.47 64.65 53.46 42.87 38.44 37.52 35.68 34.87 34.50 34.13 Nxt Seg Ms Inspired O 2 Fraction 0.21 76.47 64.65 53.46 42.87 38.44 37.52 35.68 34.87 34.50 34.13 Safety Ms Calculated PN 2 66.64 10.11 1.65 (0.04) 1.19 6.20 9.16 9.41 11.98 12.79 13.03 Buffer 51.36 Linear Transition Time 0.00 2.0 Transition O 2 Fraction 0.21 66.36 63.00 53.50 41.68 32.24 28.37 26.26 22.89 21.71 21.11 PN 2 (t) Calculated Target PN 2 19.24 10.11 1.65 (0.04) 1.19 6.20 9.16 9.41 11.98 12.79 13.03 Buffer Initial PN 2 Inspired 66.64 Target - Initial -47.4 Segment 2 Conditions Segment Depth (FSW) 0 66.36 63.00 53.50 41.68 32.24 28.37 26.26 22.89 21.71 21.11 PN 2 (t)

Comparison with USN Std Air Decompression Tables Comparison: Nobendem VS US Navy Dive Tables Depth Time Ascent Deco 40 Deco 30 Deco 20 Deco 10 Tot Deco RNT 40 Navy 40 270 1.3 15 16.3 101 Nobendem 15 16.3 105 Nobendem Safety = 10 33 34.3 97 Navy 100 50 3.3 2 24 29.3 73 Nobendem 26 29.3 78 Nobendem Safety = 10 8 28 39.3 77 Navy 100 240 3.3 14 42 84 142 285.3 ** Nobendem 17 43 101 199 363.3 68 Nobendem Safety = 10 31 53 122 263 445.3 52 Navy 160 15 5.3 1 4 10.3 49 Nobendem 4 9.3 47 Nobendem Safety = 10 8 13.3 47 Navy 160 60 5.3 9 19 33 69 135.3 101 Nobendem 10 19 33 73 140.3 108 Nobendem Safety = 10 17 20 45 105 192.3 89

Navy Table DCS Risks 2.5% No Deco 5% Deco Dive 7.5% Repet Deco Dive Too Scary For Me! Fudge Factors: Use Next Deeper Depth Use Next Longer Time Descent Time Counts as Bottom Time Shallower Depth Counts As If Still At Deepest Depth Ascent Slower Than 5 Minutes Counts as Bottom Time

Nobendem Safety Compensation Dive to 75 FSW for 43 minutes, then to 83 FSWfor 15 minutes, then surface. Comparison: Nobendem Safety Models Depth Time Depth Time Ascent Deco 20 Deco 10 Tot Deco Straight Nobendem 75 43 83 15 2.7 15 17.7 Navy Rules 80 50 90 20 2.7 2 26 30.7 Nobendem w/ Safety = 20 75 43 83 15 2.7 3 31 36.7 Recommendation: Always Dive Nobendem with SE=20!

Repet Dives USN Tables Look only at 120 min tissue Assign Repet Group Based on N2 Level at End Of Dive Exponential N2 Decay Over Surface Interval Fudge! Decays With T 1/2 = 160 min!! Look at Next Dive Bottom Depth?Time At Depth To Reach N2 Level in 120 Min Tissue Apply That RNT as Pre-charge to All Tissue Groups Add RNT to Next Dive s Planned Bottom Time

Repet Dives Nobendem Match USN Mechanism Calculate RNT and Apply to Tissues of 120 Min or Less For Tissue Compartments > 120 Min Take the Greater Of: The RNT Calculated Load The 4/3 Exponential Decay for the Tissue Compartment Equivalent to Navy Tables for Short - Intermediate Dives More Conservative for Longer Dives Don t get ** ed Out

Using Nobendem Determine your Dive Type Single; Multiple (Repet); Long (more than 6 segments) Select the Appropriate Spreadsheet Page Select Tools, Macros, Run Macro Reset (Short / Long) for (6 / 12) segment spreadsheet Modify the Safety Enhancement as required 20 for wet dives recommended 55-65 for dry dives (chamber) 55 if < 40.AND. no undeserved DCS 65 if > 39.OR. any undeserved DCS

Using Nobendem Enter the barometric pressure at waters surface Use Pressure Calculator if unknown If above sea level, requires 2.2 days for equilibration Enter equilibrium breathing gas mix FiO 2 Air = 0.21 Enter the descent time in Min.Tenths Enter the descent breathing gas FiO 2 If diving Nitrox, then run the Change Oxy Macro! Enter the depth of the first segment of the dive FSW beneath the surface (FFW/FSW handled automatically)

Using Nobendem Enter Time Spent at Segment 1 Depth (Min) Enter the Segment 1 breathing gas FiO 2 Enter the Travel Time to the Segment 2 depth Enter the Breathing Gas Mix for the Transition Repeat steps for other pre-deco dive depths After LAST depth/time segment SKIP transition Enter shallowest Depth with NO RED in Buffer Next Segment depth controls permissible N 2 comparison

Using Nobendem Go back to previous seg, enter ascent time & gas 30 FPM max ascent rate (value suggested) May be able to decrease Deco depth if long ascent! Go to NEXT seg - Enter desired next stop depth Return to first stop - enter Time to clear RED Try various time periods till segment buffer values zero out This is the amount of time needed at the deco stop Enter segment transition time gas mix Repeat process until you reach the surface!

Example Dive Plan a Deco Schedule for 80 FSW X 52 Min Safety Enhancement = 20 Air dive 3 minute descent (pretty slow!) 52 min bottom time Optimize first stop! Second stop 1/2 way to the surface

-0.693147181 30 N 2 Tissue Compartments Copyright (C) 1998 Benton P. Zwart 5 10 20 40 80 120 160 320 480 640 T1/2 Initial Tissue PN 2 26.07 2.2990 2.0083 1.7060 1.3905 1.2726 1.2619 1.2548 1.2350 1.2208 1.2137 Slope Safety Enhancement (20-100) 20 103.60 87.58 72.42 58.08 52.08 50.83 48.33 47.24 46.74 46.24 Intercept Local Barometer (mmhg) 760 1.9968 1.7642 1.5224 1.2700 1.1757 1.1671 1.1614 1.1456 1.1342 1.1285 Safety Slope Initial Steady State FiO2 0.21 88.08 75.26 63.14 51.66 46.86 45.86 43.86 42.99 42.59 42.19 Safety Intercept Depth Gauge Must = 0 at Surface of Water! Linear Transition Time 3.00 2.7 40.85 33.37 29.60 27.78 26.91 26.63 26.49 26.28 26.21 26.17 PN 2 (t) Transition O 2 Fraction 0.21 Calculated Target PN 2 89.27 287.61 248.31 208.95 169.36 153.92 151.81 148.74 146.06 144.42 143.36 Nxt Seg Ms Initial PN 2 Inspired 26.07 247.89 216.46 184.97 153.29 140.94 139.26 136.79 134.65 133.35 132.49 Safety Ms Target - Initial 63.2 207.04 183.08 155.37 125.51 114.03 112.63 110.31 108.38 107.14 106.32 Buffer Segment 1 Conditions Segment Depth (FSW) 80 89.23 87.75 79.43 64.30 49.53 42.88 39.15 32.99 30.77 29.63 PN 2 (t) Segment Time (Min) 52 126.90 107.90 89.66 72.12 64.92 63.55 60.96 59.66 59.02 58.45 Nxt Seg Ms Inspired O 2 Fraction 0.21 108.30 93.10 78.51 64.47 58.71 57.62 55.54 54.51 53.99 53.53 Safety Ms Calculated PN 2 89.27 19.06 5.35 (0.92) 0.18 9.18 14.74 16.39 21.52 23.22 23.90 Buffer 80.00 Linear Transition Time 2.30 2.3 Transition O 2 Fraction 0.21 79.32 83.14 77.85 64.14 49.75 43.12 39.37 33.13 30.87 29.71 PN 2 (t) Calculated Target PN 2 33.97 28.98 9.96 0.66 0.34 8.96 14.50 16.17 21.38 23.12 23.83 Buffer Initial PN 2 Inspired 89.27 Target - Initial -55.3

Segment 2 Conditions Segment Depth (FSW) 10 41.45 53.94 61.93 58.05 48.07 42.46 39.07 33.15 30.93 29.77 PN 2 (t) Segment Time (Min) 13 115.33 97.80 81.09 65.14 58.53 57.22 54.66 53.47 52.90 52.36 Nxt Seg Ms Inspired O 2 Fraction 0.21 98.25 84.23 70.86 58.10 52.81 51.76 49.72 48.76 48.31 47.88 Safety Ms Calculated PN 2 33.97 56.80 30.29 8.93 0.05 4.74 9.30 10.65 15.61 17.38 18.11 Buffer 10.00 Linear Transition Time 0.20 0.2 Transition O 2 Fraction 0.21 41.19 53.64 61.72 57.96 48.04 42.45 39.07 33.15 30.93 29.77 PN 2 (t) Calculated Target PN 2 30.02 57.06 30.60 9.13 0.14 4.77 9.32 10.65 15.61 17.38 18.11 Buffer Initial PN 2 Inspired 33.97 Target - Initial -3.95 Segment 3 Conditions Segment Depth (FSW) 5 31.42 38.37 48.87 51.57 45.85 41.41 38.50 33.05 30.91 29.77 PN 2 (t) Segment Time (Min) 15 103.60 87.58 72.42 58.08 52.08 50.83 48.33 47.24 46.74 46.24 Nxt Seg Ms Inspired O 2 Fraction 0.21 88.08 75.26 63.14 51.66 46.86 45.86 43.86 42.99 42.59 42.19 Safety Ms Calculated PN 2 30.02 56.66 36.89 14.26 0.10 1.02 4.45 5.37 9.94 11.68 12.42 Buffer 5.00 Linear Transition Time 0.00 0.2 Transition O 2 Fraction 0.21 31.42 38.37 48.87 51.57 45.85 41.41 38.50 33.05 30.91 29.77 PN 2 (t) Calculated Target PN 2 26.07 56.66 36.89 14.26 0.10 1.02 4.45 5.37 9.94 11.68 12.42 Buffer Initial PN 2 Inspired 30.02 Target - Initial -3.95 Segment 4 Conditions Segment Depth (FSW) 0 31.42 38.37 48.87 51.57 45.85 41.41 38.50 33.05 30.91 29.77 PN 2 (t)

Results Comparison Navy => 80 for 60 needs 17 min @ 10 FSW Nobendem SE(20) => 28 min Deco Stops Nobendem SE(0) => 13 min @ 10 FSW Nobendem SE(0) 80 for 60 => 18 min @ 10 FSW Nobendem SE(20), 1 stop => 31 min @ 10 FSW EXTRA CREDIT!! WHY is the Nobendem SE(20) 2-stop 3 min shorter than the SE(20) 1-stop?

References Egi SM, Brubakk AO. Diving at Altitude: a review of decompression strategies. Undersea & Hyperbaric Medicine, Vol 22, No. 3, 1995. Thalmann ED, Butler FK. A procedure for doing multiple level dives on air using repetitive groups. US Navy Experimental Dive Unit Report No. 13-83. Workman RD. Calculation of air saturation decompression tables. US Navy Experimental Dive Unit Report No. 11-57. Des Granges M. Standard air decompression tables. US Navy Experimental Dive Unit Report No. 5-57. Naval Sea Systems Command. U.S. Navy Diving Manual Volume 1 (Air Diving). Revision 3, 13 Feb 93. Hamilton JD. High Altitude Decompression Procedures. Naval Experimental Dive Unit Memo, 28 Feb 86 (10560/TA86-06). Boni M, Schibli R, Nussberger P, Buhlmann A. Diving at diminished atmospheric pressure. Undersea Biomedical Research, Vol 3(3), 1976, 189-204.

QUESTIONS?? MORE EXAMPLES General Example #1 PhD Entrance Exam TT-5 Profile Comparisons Ascent Rate from 165 FSW Your Worst Deco Nightmare Repets, with a twist! Sprinkler Check at 165 Download All at http://www.brooks.af.mil/web/hyper/