Isobaric counterdiffusion

In physiology, isobaric counterdiffusion (ICD) is the diffusion of different gases into and out of tissues while under a constant ambient pressure, after a change of gas composition, and the physiological effects of this phenomenon. The term inert gas counterdiffusion is sometimes used as a synonym, but can also be applied to situations where the ambient pressure changes. It has relevance in mixed gas diving and anesthesiology. Isobaric counterdiffusion was first described by Graves, Idicula, Lambertsen, and Quinn in 1973 in subjects who breathed one gas mixture (in which the inert component was nitrogen or neon) while being surrounded by another (helium based). In medicine, ICD is the diffusion of gases in different directions that can increase the pressure inside open air spaces of the body and surrounding equipment. An example of this would be a patient breathing nitrous oxide in an operating room (surrounded by air). Cuffs on the endotracheal tubes must be monitored as nitrous oxide will diffuse into the air filled space causing the volume to increase. In laparoscopic surgery, nitrous oxide is avoided since the gas will diffuse into the abdominal or pelvic cavities causing an increase in internal pressure. In the case of a tympanoplasty, the skin flap will not lay down as the nitrous oxide will be diffusing into the middle ear. In underwater diving, ICD is the diffusion of one inert gas into body tissues while another inert gas is diffusing out. While not strictly speaking a phenomenon of decompression, it is a complication that can occur during decompression, and that can result in the formation or growth of bubbles without changes in the environmental pressure. If the gas that is diffusing into a tissue does so at a rate which exceeds the rate of the other leaving the tissue, it can raise the combined gas concentration in the tissue to a supersaturation sufficient to cause the formation or growth of bubbles, without changes in the environmental pressure, and in particular, without concurrent decompression.