Engineering topics

Foster, Philip P.

Publications and source records attributed to Foster, Philip P..

5 records

NASA NTRS2003

Patent foramen ovale and paradoxical systemic embolism: a bibliographic review

A patent foramen ovale (PFO) has been reported to be an important risk factor for cardioembolic cerebrovascular accidents through paradoxical systemic embolization, and it provides one potential mechanism for the paradoxical systemic embolization of venous gas bubbles produced after altitude or hyperbaric decompressions. Here, we present in a single document a summary of the original findings and views from authors in this field. It is a comprehensive review of 145 peer-reviewed journal articles related to PFO that is intended to encourage reflection on PFO detection methods and on the possible association between PFO and stroke. There is a heightened debate on whether aviators, astronauts, and scuba divers should go through screening for PFO. Because it is a source of an important controversy, we prefer to present the findings in the format of a neutral bibliographic review independent of our own opinions. Each cited peer-reviewed article includes a short summary in which we attempt to present potential parallels with the pathophysiology of decompression bubbles. Two types of articles are summarized, as follows. First, we report the original clinical and physiological findings which focus on PFO. The consistent reporting sequence begins by describing the method of detection of PFO and goal of the study, followed by bulleted results, and finally the discussion and conclusion. Second, we summarize from review papers the issues related only to PFO. At the end of each section, an abstract with concluding remarks based on the cited articles provides guidelines.

NASA Discipline Environmental Health↗

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 NTRS2000

Effect of In-Flight Exercise and Extravehicular Activity on Postflight Stand Tests

The purpose of this study was to determine whether exercise performed by Space Shuttle crewmembers during short-duration spaceflights (9-16 days) affects the heart rate (HR) and blood pressure (BP) responses to standing within 2-4 hr of landing. Thirty crewmembers performed self-selected in-flight exercise and maintained exercise logs to monitor their exercise intensity and duration. A 10min stand test, preceded by at least 6 min of quiet supine rest, was completed 10- 15 d before launch (PRE) and within four hours of landing (POST). Based upon their in-flight exercise records, subjects were grouped as either high (HIex: = 3x/week, HR = 70% ,HRMax, = 20 min/session, n = 11), medium (MEDex: = 3x/week, HR = 70% HRmax, = 20 min/session, n = 10), or low (LOex: = 3x/week, HR and duration variable, n = 11) exercisers. HR and BP responses to standing were compared between groups (ANOVA, or analysis of variance, P < 0.05). There were no PRE differences between the groups in supine or standing HR and BP. Although POST supine HR was similar to PRE, all groups had an increased standing HR compared to PRE. The increase in HR upon standing was significantly greater after flight in the LOex group (36+/-5 bpm) compared to HIex or MEDex groups (25+/-1bpm; 22+/-2 bpm). Similarly, the decrease in pulse pressure (PP) from supine to standing was unchanged after spaceflight in the MEDex and HIex groups, but was significantly less in the LOex group (PRE: -9+/- 3, POST: -19+/- 4 mmHg). Thus, moderate to high levels of in-flight exercise attenuated HR and PP responses to standing after spaceflight compared.

Lee, Stuart M. C.↗

NASA NTRS2000

A Pilot Study for Applying an Extravehicular Activity Exercise Prebreathe Protocol to the International Space Station

Decompression sickness (DCS) is a serious risk to astronauts performing extravehicular activity (EVA). To reduce this risk, the addition of ten minutes of moderate exercise (75% VO2pk) during prebreathe has been shown to decrease the total prebreathe time from 4 to 2 hours and to decrease the incidence of DCS. The overall purpose of this pilot study was to develop an exercise protocol using flight hardware and an in-flight physical fitness cycle test to perform prebreathe exercise before an EVA. Eleven subjects volunteered to participate in this study. The first objective of this study was to compare the steady-state heart rate (HR) and oxygen consumption (VO2) from a submaximal arm and leg exercise (ALE) session with those predicted from a maximal ALE test. The second objective was to compare the steady-state HR and V02 from a submaximal elastic tube and leg exercise (TLE) session with those predicted from the maximal ALE test. The third objective involved a comparison of the maximal ALE test with a maximal leg-only (LE) test to conform to the in- flight fitness assessment test. The 75% VO2pk target HR from the LE test was significantly less than the target HR from the ALE test. Prescribing exercise using data from the maximal ALE test resulted in the measured submaximal values being higher than predicted VO2 and HR. The results of this pilot study suggest that elastic tubing is valid during EVA prebreathe as a method of arm exercise with the flight leg ergometer and it is recommended that prebreathe countermeasure exercise protocol incorporate this method.

Woodruff, Kristin K.↗

NASA NTRS2000

Inflight Exercise Regimen for the 2-Hour Prebreathe Protocol

A 10 min aerobic prebreathe exercise up to 75% V-O2(sub max) on a dual-cycle ergometer, included in the 2-hour prebreathe protocol, has been shown to dramatically reduce the incidence of decompression sickness (DCS) at altitude. In-flight only leg ergometry will be available. A balanced exercise was developed using surgical tubing with the ergometer on-orbit. We hypothesize that a 75% V02max workload, individually prescribed, would be achieved using a target heart rate to regulate the intensity of the arm exercise. VO2, heart rate (HR) / ECG, V-CO2 /V-O2, V(sub E), and V(sub T), and rate of perceived exertion (Borg scale) were measured in eleven healthy subjects who passed a US Air Force Class III Physical examination. A V-O2 peak test was performed to assess the sub-maximal exercise prescription. Two series of sub-maximal tests were performed: (1) leg ergometer/hand ergometer and (2) leg ergometer/surgical tubes. We found no significant differences (P > 0.05) in comparing the means for V-O2 and HR between the predicted and measured values during the final 4 minute-stage at "75% V-O2 workload" or between the two types of sub-maximal tests. The prescribed prebreathe sub-maximal exercise performed with flight certified surgical tubes was achieved using the target HR.

Foster, Philip P.↗