Acute Mountain Sickness and Hemoconcentration in Next Generation Spacecraft

This slide presentation reviews the threat astronauts face from acute mountain sickness (AMS). It includes information about the symptoms of AMS, the potential threat to astronauts, and future efforts to mitigate the AMS threat

Environmental Physiology at the Johnson Space Center: Past, Present, and Future

This viewgraph presentation reviews the work in environmental physiology done at Johnson Space Center (JSC). The work is aimed at keeping astronauts healthy. This is a different approach than treating the sick, and is more of an occupational health model. The reduction of risks is the main emphasis for this work. They emphasis is to reduce the risk of decompression sickness (DCS) and acute mountain sickness (AMS). The work in environmental physiology encompasses the following areas: (1) Pressure: hypobaric and hyperbaric (2) Gases: hypoxia and hyperoxia, hypercapnia--closed space issues, inert gas physiology / respiration (3) Temperature: hypothermia and hyperthermia, thermal comfort, Protective clothing diving, aviation, mountaineering, and space (4) Acceleration (5) Noise and Vibration (6) Exercise / Performance (6) Acclimatization / Adaptation: engineering solutions when necessary. This presentation reviews the work done at JSC in the areas of DCS and AMS

A Start Toward Micronucleus-Based Decompression Models; Altitude Decompression

Do gaseous micronuclei trigger the formation of bubbles in decompression sickness (DCS)? Most previous instructions for DCS prevention have been oriented toward supersaturated gas in tissue. We are developing a mathematical model that is oriented toward the expected behavior of micronuclei. The issue is simplified in altitude decompressions because the aviator or astronaut is exposed only to decompression, whereas in diving there is a compression before the decompression. The model deals with four variables: duration of breathing of 100% oxygen before going to altitude (O2 prebreathing), altitude of the exposure, exposure duration, and rate of ascent. Assumptions: a) there is a population of micronuclei of various sizes having a range of characteristics, b) micronuclei are stable until they grow to a certain critical nucleation radius, c) it takes time for gas to diffuse in or out of micronuclei, and d) all other variables being equal, growth of micronuclei upon decompression is more rapid at high altitude because of the rarified gas in the micronuclei. To estimate parameters, we use a dataset of 4,756 men in altitude chambers exposed to various combinations of the model s variables. The model predicts occurrence of DCS symptoms quite well. It is notable that both the altitude chamber data and the model show little effect of O2 prebreathing until it lasts more than 60 minutes; this is in contrast to a conventional idea that the benefit of prebreathing is directly due to exponential washout of tissue nitrogen. The delay in response to O2 prebreathing can be interpreted as time required for outward diffusion of nitrogen; when the micronuclei become small enough, they are disabled, either by crushing or because they cannot expand to a critical nucleation size when the subject ascends to altitude

Empirical models for use in designing decompression procedures for space operations

Empirical models for predicting the incidence of Type 1 altitude decompression sickness (DCS) and venous gas emboli (VGE) during space extravehicular activity (EVA), and for use in designing safe denitrogenation decompression procedures are developed. The models are parameterized using DCS and VGE incidence data from NASA and USAF manned altitude chamber decompression tests using 607 male and female subject tests. These models, and procedures for their use, consist of: (1) an exponential relaxation model and procedure for computing tissue nitrogen partial pressure resulting from a specified prebreathing and stepped decompression sequence; (2) a formula for calculating Tissue Ratio (TR), a tissue decompression stress index; (3) linear and Hill equation models for predicting the total incidence of VGE and DCS attendant with a particular TR; (4) graphs of cumulative DCS and VGE incidence (risk) versus EVA exposure time at any specified TR; and (5) two equations for calculating the average delay period for the initial detection of VGE or indication of Type 1 DCS in a group after a specific denitrogenation decompression procedure. Several examples of realistic EVA preparations are provided

The Decompression Sickness and Venous Gas Emboli Consequences of Air Breaks During 100% Oxygen Prebreathe

Not enough is known about the increased risk of hypobaric decompression sickness (DCS) and production of venous (VGE) and arterial (AGE) gas emboli following an air break in an otherwise normal 100% resting oxygen (O2) prebreathe (PB), and certainly a break in PB when exercise is used to accelerate nitrogen (N2) elimination from the tissues. Current Aeromedical Flight Rules at the Johnson Space Center about additional PB payback times are untested, possibly too conservative, and therefore not optimized for operational use

An Evidenced-Based Approach for Estimating Decompression Sickness Risk in Aircraft Operations

Estimating the risk of decompression Sickness (DCS) in aircraft operations remains a challenge, making the reduction of this risk through the development of operationally acceptable denitrogenation schedules difficult. In addition, the medical recommendations which are promulgated are often not supported by rigorous evaluation of the available data, but are instead arrived at by negotiation with the aircraft operations community, are adapted from other similar aircraft operations, or are based upon the opinion of the local medical community. We present a systematic approach for defining DCS risk in aircraft operations by analyzing the data available for a specific aircraft, flight profile, and aviator population. Once the risk of DCS in a particular aircraft operation is known, appropriate steps can be taken to reduce this risk to a level acceptable to the applicable aviation community. Using this technique will allow any aviation medical community to arrive at the best estimate of DCS risk for its specific mission and aviator population and will allow systematic reevaluation of the decisions regarding DCS risk reduction when additional data are available

Gender Consideration in Experiment Design for Air Break in Prebreathe

If gender is a confounder of the decompression sickness (DCS) or venous gas emboli (VGE) outcomes of a proposed air break in oxygen prebreathe (PB) project, then decisions about the final experiment design must be made. We evaluated if the incidence of DCS and VGE from tests in altitude chambers over 20 years were different between men and women after resting and exercise PB protocols. Nitrogen washout during PB is our primary risk mitigation strategy to prevent subsequent DCS and VGE in subjects. Bubbles in the pulmonary artery (venous blood) were detected from the precordial position using Doppler ultrasound bubble detectors. The subjects were monitored for VGE for four min at about 15 min intervals for the duration of the altitude exposure, with maximum bubble grade assigned a Spencer Grade of IV

Gender Consideration in Experiment Design for Airbrake in Prebreathe

If gender is a confounder of the decompression sickness (DCS) or venous gas emboli (VGE) outcomes of a proposed air break in oxygen prebreathe (PB) project, then decisions about the final experiment design must be made. We evaluated if the incidence of DCS and VGE from tests in altitude chambers over 20 years were different between men and women after resting and exercise prebreathe protocols. Nitrogen washout during PB is our primary risk mitigation strategy to prevent subsequent DCS and VGE in subjects. Bubbles in the pulmonary artery (venous blood) were detected from the precordial position using Doppler ultrasound bubble detectors. The subjects were monitored for VGE for four min at about 15 min intervals for the duration of the altitude exposure, with maximum bubble grade assigned a Spencer Grade of IV. There was no difference in DCS incidence between men and women in either PB protocol. The incidence of VGE and Grade IV VGE is statistically lower in women compared to men after resting PB. Even when 10 tests were compared with Mantel-Haenszel 2 where both men (n = 168) and women (n = 92) appeared, the p-value for VGE incidence was still significant at 0.03. The incidence of VGE and Grade IV VGE is not statistically lower in women compared to men after exercise PB. Even when six tests were compared with Mantel-Haenszel x2 where both men (n = 165) and women (n = 49) appeared, the p-value for VGE incidence was still not significant at 0.90. Our goal is to understand the risk of brief air breaks during PB without other confounding variables invalidating our conclusions. The cost to additionally account for the confounding role of gender on VGE outcome after resting PB is judged excessive. Our decision is to only evaluate air breaks in the exercise PB protocol. So there is no restriction to recruiting women as test subjects

The effect of exercise on venous gas emboli and decompression sickness in human subjects at 4.3 psia

The contribution of upper body exercise to altitude decompression sickness while at 4.3 psia after 3.5 or 4.0 hours of 100% oxygen prebreathing at 14.7 psia was determined by comparing the incidence and patterns of venous gas emboli (VGE), and the incidence of Type 1 decompression sickness (DCS) in 43 exercising male subjects and 9 less active male Doppler Technicians (DT's). Each subject exercised for 4 minutes at each of 3 exercise stations while at 4.3 psia. An additional 4 minutes were spent monitoring for VGE by the DT while the subject was supine on an examination cot. In the combined 3.5 and 4.0 hour oxygen prebreathe data, 13 subjects complained of Type 1 DCS compared to 9 complaints from DT's. VGE were detected in 28 subjects compared to 14 detections from DT's. A chi-square analysis of proportions showed no statistically significantly difference in the incidence of Type 1 DCS or VGE between the two groups; however, the average time to detect VGE and to report Tyep 1 DCS symptoms were statistically different. It was concluded that 4 to 6 hours of upper body exercise at metabolic rates simulating EVA metabolic rates hastens the initial detection of VGE and the time to report Type 1 DCS symptoms as compared to DT's

Modeling Oxygen Prebreathe Protocols for Exploration Extravehicular Activities Using Variable Pressure Suits

Exploration missions are expected to use variable pressure extravehicular activity (EVA) spacesuits as well as a spacecraft "exploration atmosphere" of 56.5 kPa (8.2 psia), 34% O2, both of which provide the possibility of reducing the oxygen prebreathe times necessary to reduce decompression sickness (DCS) risk. Previous modeling work predicted 8.4% DCS risk for an EVA beginning at the exploration atmosphere, followed by 15 minutes of in-suit O2 prebreathe, and 6 hours of EVA at 29.6 kPa (4.3 psia). In this study we model notional prebreathe protocols for a variable pressure suit where the exploration atmosphere is unavailable