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At least 145 records · Page 8
All sourcesNASA NTRSDOE OSTI
NASA NTRS2005

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.

Conkin, Johnny↗
NASA NTRS2004

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. A 10 min air break at 90 min into a 120 min PB that includes initial dual-cycle ergometry for 10 min will show a measurable increase in the risk of DCS and VGE after ascent to 4.3 psia compared to a 10 min break at 15 min into the PB, or when there is no break in PB. Data collection with humans begins in 2005, but here we first evaluate the hypothesis using three models of tissue N2 kinetics: Model I is a simple single half-time compartment exponential model, Model II is a three compartment half-time exponential model, and Model III is a variable half-time compartment model where the percentage of maximum O2 consumption for the subject during dual-cycle ergometry exercise defines the half-time compartment. Model I with large rate constants to simulate an exercise effect always showed a late break in PB had the greatest consequence. Model II showed an early break had the greatest consequence. Model III showed there was no difference between early or late break in exercise PB. Only one of these outcomes will be observed when humans are tested. Our results will favor one of these models, and so advance our understanding of tissue N2 kinetics, and of altitude DCS after an air break in PB.

Conkin, J.↗
NASA NTRS2007

Spaceflight Decompression Sickness Contingency Plan

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.

Dervay, Joseph P.↗
NASA NTRS2010

Decompression Sickness After Air Break in Prebreathe Described with a Survival Model

Data from Brooks City-Base show the decompression sickness (DCS) and venous gas emboli (VGE) consequences of air breaks in a resting 100% O2 prebreathe (PB) prior to a hypobaric exposure. METHODS: DCS and VGE survival times from 95 controls for a 60 min PB prior to 2-hr or 4-hr exposures to 4.37 psia are statistically compared to 3 break in PB conditions: a 10 min (n=40), 20 min (n=40), or 60 min break (n=32) 30 min into the PB followed by 30 min of PB. Ascent rate was 1,524 meters / min and all exposures included light exercise and 4 min of VGE monitoring of heart chambers at 16 min intervals. DCS survival time for combined control and air breaks were described with an accelerated log logistic model where exponential N2 washin during air break was described with a 10 min half-time and washout during PB with a 60 min half-time. RESULTS: There was no difference in VGE or DCS survival times among 3 different air breaks, or when air breaks were compared to control VGE times. However, 10, 20, and 60 min air breaks had significantly earlier survival times compared to control DCS times, certainly early in the exposures. CONCLUSION: Air breaks of 10, 20, and 60 min after 30 min of a 60 min PB reduced DCS survival time. The survival model combined discrete comparisons into a global description mechanistically linked to asymmetrical N2 washin and washout kinetics based on inspired pN2. Our unvalidated regression is used to compute additional PB time needed to compensate for an air break in PB within the range of tested conditions.

Conkin, J.↗
NASA NTRS2001

Combining Information on Multiple Detection Techniques to Estimate the Effect of Patent Foramen Ovale on Susceptibility to Decompression Illness

The assembly and the maintenance of the International Space Station is expected to require hundreds of extravehicular excursions (EVA's) in the next 10 years. During an EVA, in order to allow movement and bending of limbs, spacesuit pressures are reduced to about 4.3 psi. as compared with about 14.7 psi. for normal atmospheric pressure at sea level. However, the exposure of astronauts to reduced pressures in spacesuits, is conducive to fonnation and growth of gas bubbles within venous blood or tissues, which could cause decompression illness (DCI), a pathology best known to occur among deep-sea divers when they return to the surface. To reduce the risk of DCI, astronauts adjust to the reduced pressure in stages for a prolonged time known as a "pre-breathe" period prior to their extravehicular activity. Despite the use of pre-breathe protocols, an increased risk of DCI can arise for about 25% of humans who have a small hole, known as a patent foramen ovale (PFO), between two chambers of the heart. The atrial septum's fossa oval is, an embryological remnant of a flap between the septae primum and secundum allows fetal right atrial blood to pass into the left atrium, and usually closes after birth (Hagen, et al,. 1984). If fusion does not occur, a valve-like opening, the foramen ovale persists between the two atria. It has been suggested that astronauts with PFO's might be at greater risk of stroke or other serious neurological DCI because bubbles from a venous site may traverse a PFO, travel to the aorta and then enter the cerebral circulatory system causing a stroke (Figure 1). Astronauts are not now screened for PFO's, however consideration is being given to doing so. Here, we study three main methods abbreviated here as "ITE", "TCD" and "TEE", for detecting PFO's in living subjects. All involve the introduction of bubbles into a vein, immediately after which a sensory probe attempts to detect the bubbles in systemic circulation. Presence of the injected bubbles in the systemic circulation is indicative of a PFO. More detailed descriptions are given after the explanation of PFO's under Figure I. Even if a true PFO affects the risk of DCI, there remains a question of how effective screening would be if the detection method has errors of omission and/or commission. Of the three methods studied here, TEE is the "gold standard", matching autopsy results with near-perfect sensitivity and specificity (Schneider, et al. , 1996). However TEE is also the most difficult method to implement, requiring an internal esophagal probe, and is therefore not widely used. Currently, the easiest to use and most common PFO detection method is TTE, which uses an external chest probe. This method has a specificity of near 100%, but suffers from a low sensitivity rate (about 30%). More recently, TCD has been developed, which uses ultrasound probes to detect the presence of bubbles in cerebral arteries. Studies indicate that TCD is quite effective, having a sensitivity of about 91% and a specificity of about 93% (Droste, et al., 1999) when applied correctly, however implementation is difficult and requires considerable training.

Feiveson, Alan H.↗
NASA NTRS2013

Towards Probablistic Assessment of Hypobaric Decompression Sickness Treatment

INTRODUCTION: Pressure, oxygen (O2), and time are the pillars to effective treatment of decompression sickness (DCS). The NASA DCS Treatment Model links a decrease in computed bubble volume to the resolution of a symptom. The decrease in volume is realized in two stages: a) during the Boyle's Law compression and b) during subsequent dissolution of the gas phase by the O2 window. METHODS: The cumulative distribution of 154 symptoms that resolved during repressurization was described with a log-logistic density function of pressure difference (deltaP as psid) associated with symptom resolution and two other explanatory variables. The 154 symptoms originated from 119 cases of DCS during 969 exposures in 47 different altitude tests. RESULTS: The probability of symptom resolution [P(symptom resolution)] = 1 / (1+exp(- (ln(deltaP) - 1.682 + 1.089×AMB - 0.00395×SYMPTOM TIME) / 0.633)), where AMB is 1 when the subject ambulated as part of the altitude exposure or else 0 and SYMPTOM TIME is the elapsed time in min from start of the altitude exposure to recognition of a DCS symptom. The P(symptom resolution) was estimated from computed deltaP from the Tissue Bubble Dynamics Model based on the "effective" Boyle's Law change: P2 - P1 (deltaP, psid) = P1×V1/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. V2 continues to decrease through time at P2, at a faster rate if 100% ground level O2 was breathed. The computed deltaP is the effective treatment pressure at any point in time as if the entire deltaP was just from Boyle's Law compression. DISCUSSION: Given the low probability of DCS during extravehicular activity and the prompt treatment of a symptom with options through 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.

Conkin, J.↗
NASA NTRS2014

Probabilistic Assessment of Hypobaric Decompression Sickness Treatment Success

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 + 0.795×AMB - 0.00308×Ts) / 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 | = P1×V1/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.

Conkin, Johnny↗
NASA NTRSDate not supplied

Validation of Decompression Sickness Risk Mitigation Protocols for Planetary Spaceflight Missions

BACKGROUND: Apollo missions used a 100% O2 cabin atmosphere which effectively eliminated the risk of decompression sickness (DCS) during extravehicular activity (EVA) on the moon. NASA’s future missions to the moon and Mars are expected to use nitrox gas mixtures of up to 34% O2, 66% N2, which will reduce flammability risk compared with Apollo, but will necessitate Oxygen prebreathe prior to EVA to reduce DCS risk to acceptable levels. Prebreathe protocols used on the space shuttle and International Space Station are validated for microgravity EVAs, but the significantly increased risk of DCS during equivalent ambulatory EVAs make these protocols inapplicable to planetary EVA. An “exploration atmosphere” of 56.5 kPa (8.2 psia), 34% O2, 66% N2 has been recommended by NASA as a compromise that balances prebreathe duration, hypoxia, and flammability risk, assuming a 29.6 kPa (4.3 psi) spacesuit. However, this atmosphere may not be used for vehicles that do not support frequent EVA, and with commercial providers and international providers expected to provide landers, pressurized rovers, habitats, and spacesuits, different combinations of vehicle and spacesuit atmospheres are possible and will each require validated prebreathe protocols. OVERVIEW: Key components of a multi-year strategic roadmap include: 1) Establish hypobaric chamber facility capable of supporting 8-person EVA prebreathe validation tests at saturation atmospheres up to 36% O2; 2) validate an EVA physical workload simulation for use during prebreathe validation testing; 3) validate the recommended “exploration atmosphere” prebreathe protocol; 4) validate prebreathe protocols for additional atmospheric combinations that bound the most likely potential operating ranges of future vehicles and spacesuits; and 5) update DCS risk estimation models based on results of prebreathe validation studies. DISCUSSION: Details and data from completion of the first two steps of the strategic roadmap will be presented; the third step is currently underway, with pilot results provided in a companion presentation. Steps four and five will require a multi-year series of chamber tests; collaborations are being pursued.

Andrew F. J. Abercromby↗
NASA NTRS2024

Updates to NASA’s Break-in-Prebreathe Rules Due to Type II Decompression Sickness Risk Considerations

INTRODUCTION. Investigation of a central neurological decompression sickness (DCS) case during ground testing at Johnson Space Center identified a break-in-prebreathe (BIP) 13 minutes prior to depressurization as the leading credible cause despite applicable prebreathe payback rules being followed. Applicable NASA rules, for ground and flight, directed 2:1 payback of breaks up to 10 mins in duration, regardless of when a break occurs relative to depress. Full restart of prebreathe is directed following breaks > 10 min. The adequacy of NASA’s BIP rules was evaluated prior to resuming hypobaric ground testing or ISS extravehicular activities. METHODS. The following information sources were reviewed prior to formulating recommendations: i) Type II DCS case report and investigation findings; ii) documented rationale for existing flight rules, iii) consultations with subject matter experts involved in definition of existing flight rules (several of whom had since left NASA), iv) relevant published literature, v) model estimates of tissue on-gassing and off-gassing, and vi) NASA’s operational experience with late breaks in prebreathe. RESULTS. NASA’s nominal prebreathe protocols are validated via extensive ground testing to ensure DCS risk is reduced to within acceptable limits. Conversely, there exists a paucity of data, no validated models, and limited documentation regarding BIP risk for NASA prebreathe protocols. Flight rules implemented for shuttle and later ISS are based primarily on expert opinion and an assumption of symmetric on-gassing and off-gassing, which would make 2:1 payback a conservative mitigation for a BIP. Assumption of exponential gas kinetics makes late breaks higher risk, or require greater payback, than earlier breaks. Two BIPs have occurred using the current ISS prebreathe protocol, each of which was followed by greater than 2:1 payback and at least 59 minutes of 100% O2 pre-depress. No DCS cases have been reported during shuttle or ISS EVA operations. DISCUSSION. Interim changes were implemented to protect against late breaks during ground and flight prebreathes by ensuring negligible difference in conservatively modeled ppN2 pre-depress compared to nominal validated protocols. Additional documentation and literature review as well as chamber test planning are ongoing with the objective of further ground and flight rule updates and validation of a BIP risk model.

Prebreathe↗
NASA NTRS2024

Updates to NASA’s Break-in-Prebreathe Rules Due to Type II Decompression Sickness Risk Considerations

INTRODUCTION. Investigation of a central neurological decompression sickness (DCS) case during ground testing at Johnson Space Center identified a break-in-prebreathe (BIP) 13 minutes prior to depressurization as the leading credible cause despite applicable prebreathe payback rules being followed. Applicable NASA rules, for ground and flight, directed 2:1 payback of breaks up to 10 mins in duration, regardless of when a break occurs relative to depress. Full restart of prebreathe is directed following breaks > 10 min. The adequacy of NASA’s BIP rules was evaluated prior to resuming hypobaric ground testing or ISS extravehicular activities. METHODS. The following information sources were reviewed prior to formulating recommendations: i) Type II DCS case report and investigation findings; ii) documented rationale for existing flight rules, iii) consultations with subject matter experts involved in definition of existing flight rules (several of whom had since left NASA), iv) relevant published literature, v) model estimates of tissue on-gassing and off-gassing, and vi) NASA’s operational experience with late breaks in prebreathe. RESULTS. NASA’s nominal prebreathe protocols are validated via extensive ground testing to ensure DCS risk is reduced to within acceptable limits. Conversely, there exists a paucity of data, no validated models, and limited documentation regarding BIP risk for NASA prebreathe protocols. Flight rules implemented for shuttle and later ISS are based primarily on expert opinion and an assumption of symmetric on-gassing and off-gassing, which would make 2:1 payback a conservative mitigation for a BIP. Assumption of exponential gas kinetics makes late breaks higher risk, or require greater payback, than earlier breaks. Two BIPs have occurred using the current ISS prebreathe protocol, each of which was followed by greater than 2:1 payback and at least 59 minutes of 100% O2 pre-depress. No DCS cases have been reported during shuttle or ISS EVA operations. DISCUSSION. Interim changes were implemented to protect against late breaks during ground and flight prebreathes by ensuring negligible difference in conservatively modeled ppN2 pre-depress compared to nominal validated protocols. Additional documentation and literature review as well as chamber test planning are ongoing with the objective of further ground and flight rule updates and validation of a BIP risk model.

Prebreathe↗
NASA NTRS2024

Updates to NASA’S Break-in-Prebreathe Flight Rules Due to Type II Decompression Sickness Risk Considerations

Investigation of a central neurological decompression sickness (DCS) case during hypobaric ground testing at Johnson Space Center (JSC) identified a ~3 min break-in-prebreathe (BiP) late in the prebreathe (13 min prior to depressurization) as the leading credible cause for the DCS case. This occurred despite applicable prebreathe payback rules being followed. Applicable NASA rules, for ground and flight, directed 2:1 payback of breaks up to 10 min in duration, regardless of when a break occurs relative to depress. Breaks lasting longer than 10 min require a complete restart of the prebreathe protocol. The adequacy of NASA’s BiP rules was evaluated prior to resuming any hypobaric ground testing or International Space Station (ISS) extravehicular activity (EVA). Of particular interest to the authors was the timing of the BiP in relation to the overall prebreathe timeline. Although there exists no agreed-upon definition, a ‘late’ BiP means towards the end of the prebreathe period, and in particular, the last hour prior to depressurization. The following information sources were reviewed prior to formulating recommendations: i) the type II DCS case report and findings from the investigation; ii) documented rationale for existing flight rules, iii) consultations with subject matter experts involved in definition of existing flight rules (several of whom had since left NASA); iv) relevant published literature; v) tissue gas loading model estimates; and vi) NASA’s operational experience with late breaks in prebreathe.

Andrew F J Abercromby↗
NASA NTRSDate not supplied

Assessing the Influence of Decompression Sickness on Medical Risk for Artemis

As NASA begins to shift its focus from LEO missions to the Moon and beyond, our understanding of the risk associated with human spaceflight is challenged by mission profiles and objectives far different from preceding missions. For Artemis, one of these aspects is surface Extra Vehicular Activity (EVA) tempo, in which the crew will perform 3 to 4 surface EVA’s in quick succession. The crew health and performance risk associated with EVA Decompression Sickness (DCS) and its associated countermeasures, is an important consideration for Artemis missions given this new and unprecedented EVA frequency. Successfully completing Artemis mission objectives relies heavily on the crew being able to perform and complete these EVAs. This analysis quantifies how medical risk changes when accounting for the expected increase in DCS risk due to the increase in EVA frequency. If there is an occurrence of DCS during a mission, appropriate downtime needs to be accounted for. Treatment for DCS requires crewmember to stop the current EVA and return to the habitat. This impacts the current EVA the crew is performing, could potentially delay the next EVA, and increases the chance of the crewmember being unable to perform future EVAs. Capturing the downtime and impact of that downtime based on the number of DCS occurrences allows us to better understand how the risk associated with DCS affects the overall medical risk and completion of missions that have more frequent EVA tempo. There are preventative strategies and mitigation countermeasures to decrease the chance of DCS occurring such as different prebreathe protocols, variable suit pressure, and vehicle pressure settings. Modeling the medical risk with and without different DCS countermeasures enables quantitative comparisons of risk reduction associated with each DCS countermeasure. We present results on how these countermeasures affect medical risks and quantify changes in the medical kit contents with respect to the countermeasures implemented within Artemis-class missions.

Clara Gasiewski↗
NASA NTRS1977

The decompression of cold neutron star matter

The ejection of cold neutron-star matter is examined, and an attempt is made to determine whether the final composition of this matter may be similar to that normally associated with the hot high-neutron-flux r-process. A semiempirical liquid-drop model is used for the nucleus, and the equilibrium composition of the matter is determined by assuming it to be in its absolute ground state at a given density. Physical mechanisms operating during the expansion are analyzed, and the composition of the ejected matter is found as a function of its density during expansion. The results indicate that it is virtually impossible for deuterium to form, that neutrons can be captured only after beta decay increases the atomic numbers of nuclei, and that no free neutrons can escape. It is concluded that neutron-star ejecta can produce heavy neutron-rich nuclei and may produce somewhat heavier nuclei than a standard r-process.

Lattimer, J. M.↗
NASA NTRS1986

The use of decompression to simulate the effect of extravehicular activity on human lymphocyte transformation

Lymphocytes from 35 subjects participating in a chamber study simulating extravehicular activity (EVA) conditions were studied. No significant differences in H3 thymidine uptake between pre chamber and post chamber response to any mitogens autologous plasma, or among circulating mononuclear cells by flow cytometry are observed. The studies could not identify the subjects who developed venous bubbles. Data from eight subjects suggests that acute stress associated with participating in the study augments in vitro lymphocyte proliferation. Results indicate EVA exposure does not greatly influence space-flight induced alterations in immune effector cell function.

Meehan, R. T.↗