ALBERT

Description: BACKGROUND: Decompression, as occurs with aviators and astronauts undergoing high altitude operations or with deep-sea divers returning to surface, can cause gas bubbles to form within the organism. Pressure changes to evoke bubble formation in vivo during depressurization are several orders of magnitude less than those required for gas phase formation in vitro in quiescent liquids. Preformed micronuclei acting as "seeds" have been proposed, dating back to the 1940's. These tissue gas micronuclei have been attributed to a minute gas phase located in hydrophobic cavities, surfactant-stabilized microbubbles, or arising from musculoskeletal activity. The lifetimes of these micronuclei have been presumed to be from a few minutes to several weeks. HYPOTHESIS: The greatest incidence of venous gas emboli (VGE) will be detected by precordial Doppler ultrasound with depressurization immediately following lower extremity exercise, with progressively reduced levels of VGE observed as the interval from exercise to depressurization lengthens. METHODS: In a blinded cross-over design, 20 individuals (15 men, 5 women) at sea level exercised by performing knee-bend squats (150 knee flexes over 10 min, 235-kcal x h(-1)) either at the beginning, middle, or end of a 2-h chair-rest period without an oxygen prebreathe. Seated subjects were then depressurized to 6.2 psia (6,706 m or 22,000 ft altitude equivalent) for 120 min with no exercise performed at altitude. RESULTS: Of the 20 subjects with VGE in the pulmonary artery, 10 demonstrated a greater incidence of bubbles with exercise performed just prior to depressurization, compared with decreasing bubble grades and incidence as the interval of rest increased prior to depressurization. No decompression illness was reported. CONCLUSIONS: There is a significant increase in decompression-induced bubble formation at 6.2 psia when lower extremity exercise is performed just prior to depressurization as compared with longer rest intervals. Analysis indicated that micronuclei half-life is on the order of an hour under these hypobaric conditions.

Description: A viewgraph presentation on the Decompression Sickness (DCS) Contingency Plan for manned spaceflight is shown. The topics include: 1) Approach; 2) DCS Contingency Plan Overview; 3) Extravehicular Activity (EVA) Cuff Classifications; 4) On-orbit Treatment Philosophy; 5) Long Form Malfunction Procedure (MAL); 6) Medical Checklist; 7) Flight Rules; 8) Crew Training; 9) Flight Surgeon / Biomedical Engineer (BME) Training; and 10) DCS Emergency Landing Site.

Description: The purpose was to develop an enhanced plan to diagnose, treat, and manage decompression sickness (DCS) during extravehicular activity (EVA). This plan is merited by the high frequency of upcoming EVAs necessary to construct and maintain the International Space Station (ISS). The upcoming ISS era will demand a significant increase in EVA. The DCS Risk and Contingency Plan provided a new and improved approach to DCS reporting, treatment, management, and training.

Description: The Risk of Decompression Sickness (DCS) is identified by the NASA Human Research Program (HRP) as a recognized risk to human health and performance in space, as defined in the HRP Program Requirements Document (PRD). This Evidence Report provides a summary of the evidence that has been used to identify and characterize this risk. Given that tissue inert gas partial pressure is often greater than ambient pressure during phases of a mission, primarily during extravehicular activity (EVA), there is a possibility that decompression sickness may occur.

Description: Suited vacuum chamber testing is critical to flight crew training, sustaining engineering, and development engineering. Most suited vacuum chamber testing at NASAs Johnson Space Center (JSC) involves crewmembers or human test subjects working at a hypobaric pressure of 4.3 psia, which requires that an oxygen prebreathe be performed prior to decompression to reduce the risk of decompression sickness (DCS). Since 1986, NASAs policy has been to require a 4-hour resting prebreathe for hypobaric chamber exposures of 4.2 psia lasting greater than 30 minutes. There have been no reports of Type II (i.e., serious, potentially life-threatening) DCS at NASA while using this prebreathe protocol. Several chamber runs, believed to be approximately 5% of all runs, are believed to have been terminated due to Type I DCS symptoms that were performance impairing; however, detailed records of DCS symptoms during suited vacuum chamber runs are not available. The adequacy of the 4-hour prebreathe protocol, as well as the processes by which prebreathe protocols and policies are established, became the subject of significant discussion in April 2018 when medical planning was initiated for chamber runs that were scheduled to occur later in 2018 that would last 8 hours or more with high metabolic rates.

Description: 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.

Description: 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.

Description: The Hypobaric Decompression Sickness (DCS) Treatment Model links a decrease in computed bubble volume from increased pressure (DeltaP), increased oxygen (O2) partial pressure, and passage of time during treatment to the probability of symptom resolution [P(symptom resolution)]. The decrease in offending volume is realized in 2 stages: a) during compression via Boyle's Law and b) during subsequent dissolution of the gas phase via the O2 window. We established an empirical model for the P(symptom resolution) while accounting for multiple symptoms within subjects. The data consisted of 154 cases of hypobaric DCS symptoms along with ancillary information from tests on 56 men and 18 women. Our best estimated model is P(symptom resolution) = 1 / (1+exp(-(ln(Delta P) - 1.510 + 0.795AMB - 0.00308Ts) / 0.478)), where (DeltaP) is pressure difference (psid), AMB = 1 if ambulation took place during part of the altitude exposure, otherwise AMB = 0; and where Ts is the elapsed time in mins from start of the altitude exposure to recognition of a DCS symptom. To apply this model in future scenarios, values of DeltaP as inputs to the model would be calculated from the Tissue Bubble Dynamics Model based on the effective treatment pressure: (DeltaP) = P2 - P1 | = P1V1/V2 - P1, where V1 is the computed volume of a spherical bubble in a unit volume of tissue at low pressure P1 and V2 is computed volume after a change to a higher pressure P2. If 100% ground level O2 (GLO) was breathed in place of air, then V2 continues to decrease through time at P2 at a faster rate. This calculated value of (DeltaP then represents the effective treatment pressure at any point in time. Simulation of a "pain-only" symptom at 203 min into an ambulatory extravehicular activity (EVA) at 4.3 psia on Mars resulted in a P(symptom resolution) of 0.49 (0.36 to 0.62 95% confidence intervals) on immediate return to 8.2 psia in the Multi-Mission Space Exploration Vehicle. The P(symptom resolution) increased to near certainty (0.99) after 2 hrs of GLO at 8.2 psia or with less certainty on immediate pressurization to 14.7 psia [0.90 (0.83 - 0.95)]. Given the low probability of DCS during EVA and the prompt treatment of a symptom with guidance from the model, it is likely that the symptom and gas phase will resolve with minimum resources and minimal impact on astronaut health, safety, and productivity.

Description: No abstract available

Description: This slide presentation combines some views of the shuttle take off, and the shuttle and space station on orbit, and some views of the underwater astronaut training , with a general discussion of Space Medicine. It begins with a discussion of the some of the physiological issues of space flight. These include: Space Motion Sickness (SMS), Cardiovascular, Neurovestibular, Musculoskeletal, and Behavioral/Psycho-social. There is also discussion of the space environment and the issues that are posed including: Radiation, Toxic products and propellants, Habitability, Atmosphere, and Medical events. Included also is a discussion of the systems and crew training. There are also artists views of the Constellation vehicles, the planned lunar base, and extended lunar settlement. There are also slides showing the size of earth in perspective to the other planets, and the sun and the sun in perspective to other stars. There is also a discussion of the in-flight changes that occur in neural feedback that produces postural imbalance and loss of coordination after return.