Venous gas emboli (VGE) in 2-D echocardiographic images following movement: grading and association with cumulative incidence of decompression sickness.

Introduction: Venous gas emboli (VGE) are a common surrogate experimental endpoint for decompression sickness (DCS). VGE numbers are graded, and the peak post-dive grade is associated with the probability of DCS (PDCS). VGE are typically graded with the subject at rest when bubble numbers are stable, and again after limb flexions which elicit a transient shower of bubbles. Detection of VGE using two-dimensional (2-D) echocardiography has become common, but the principal grading scales do not specify how to grade VGE after limb movement. Methods: This was a retrospective analysis of 1,196 man-dives following which VGE were detected using 2-D echocardiography and graded on a scale 0-4 and 41 cases of DCS occurred. PDCS was estimated for each peak post-dive VGE grade from the cumulative incidence of DCS. Two different definitions of movement VGE grades were assessed in 84 measurements; the grade was either the maximum VGE number sustained for one diastole (1-cycle) or for six cardiac cycles (6-cycle). Results: For each peak post-dive VGE grade (maximum of rest or movement) the cumulative incidences of DCS (%) were: grade 0 (0%); grade 1 (1.3%); grade 2 (2.5%); grade 3 (4.6%); grade 4 (5.7%). When grading movement VGE, 57% of 1-cycle grade 4 were reduced to grade 3 using the 6-cycle definition. Conclusions: There is a need for consensus in the research community on how to assign movement VGE grades when using 2-D echocardiography. Publications should carefully explain methodology for assigning VGE grades and consider differences in methodologies when comparing historical data sets.