The Dewey monitor: Pulse oximetry can independently detect hypoxia in a rebreather diver.


Rebreather diving has one of the highest fatality rates per man hour of any diving activity in the world. The leading cause of death is hypoxia, typically from equipment or procedural failures. Hypoxia causes very few symptoms prior to causing loss of consciousness. Additionally, since the electronics responsible for controlling oxygen levels in rebreathers often control their alarm systems, frequently divers do not receive any external warnings. This study investigated the use of a forehead pulse oximeter as an independent warning device in the event of rebreather failure. Ten test subjects (seven male, three female, median age 29, range 26-35) exercised at a targeted rate of 2 L/minute oxygen consumption while on a non-functional rebreather breathing loop (mean consumption achieved 2.09 ± 0.36 L/minute). Each subject was tested both at the surface and at pressurized depth of 77 fsw (starting pO₂=0.7 atm). The data show that a pulse oximeter could be used to provide an Mk 16 rebreather diver with a minimum mean of 49 seconds (± 17 seconds SD) of warning time after a noticeable change in blood oxygen saturation (SpO₂ ≤ 95%) but before any risk of loss of consciousness (calculated SpO₂ ≤ 80%), so that the diver may take mitigating actions. No statistical difference in warning time was found between the tests at surface and at 77 fsw (P=0.46).







Rachel Lance

Assistant Consulting Professor in the Department of Anesthesiology

Rachel Lance is a PhD biomedical engineer specializing in the application of engineering principles to examine the physiology of how the human body "fails" in extreme situations, resulting in injury and death. Her ongoing research investigates the effects of blasts, including safety limits needed to prevent injury, as well as the unique physiological requirements of survival underwater and at lowered pressures. The common thread between each of these scenarios most often tends to be respiratory physiology, as breathing is one of the most immediate needs of the human body. Dr. Lance works out of the Duke Center for Hyperbaric Medicine & Environmental Physiology.


Sophia Dunworth

Assistant Professor of Anesthesiology

John Jacob Freiberger

Adjunct Associate Professor in the Department of Anethesiology

Dr Freiberger works on the translation of basic science research on reactive oxygen species signaling into clinical practice involving hyperbaric oxygen (HBO). He has performed animal experiments in the use of HBO for ischemic preconditioning and he is currently funded to conduct a randomized controlled trial of the use of HBO for the treatment of bisphosphonate-induced osteonecrosis of the jaw. The mechanisms of action for HBO in the treatment of: diabetic wounds, bony and soft tissue radionecrosis and decompression sickness are also areas of his inquiry. Dr Freiberger also does basic epidemiological research into accidents and injuries associated with diving, high altitude exposure and other adverse conditions associated with extreme environments. Dr. Freiberger directs the fellowship program at the Duke Center for Hyperbaric Medicine and Environmental Physiology.

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