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Johnston, S. L.

Publications and source records attributed to Johnston, S. L..

11 records
All sourcesNASA NTRSDOE OSTI
NASA NTRS2017

Fluid Shifts

Introduction. NASA's Human Research Program is focused on addressing health risks associated with long-duration missions on the International Space Station (ISS) and future exploration-class missions beyond low Earth orbit. Visual acuity changes observed after short-duration missions were largely transient, but now more than 50 percent of ISS astronauts have experienced more profound, chronic changes with objective structural findings such as optic disc edema, globe flattening and choroidal folds. These structural and functional changes are referred to as the visual impairment and intracranial pressure (VIIP) syndrome. Development of VIIP symptoms may be related to elevated intracranial pressure (ICP) secondary to spaceflight-induced cephalad fluid shifts, but this hypothesis has not been tested. The purpose of this study is to characterize fluid distribution and compartmentalization associated with long-duration spaceflight and to determine if a relation exists with vision changes and other elements of the VIIP syndrome. We also seek to determine whether the magnitude of fluid shifts during spaceflight, as well as any VIIP-related effects of those shifts, are predicted by the crewmember's pre-flight status and responses to acute hemodynamic manipulations, specifically posture changes and lower body negative pressure. Methods. We will examine a variety of physiologic variables in 10 long-duration ISS crewmembers using the test conditions and timeline presented in the figure below. Measures include: (1) fluid compartmentalization (total body water by D2O, extracellular fluid by NaBr, intracellular fluid by calculation, plasma volume by CO rebreathe, interstitial fluid by calculation); (2) forehead/eyelids, tibia, and calcaneus tissue thickness (by ultrasound); (3) vascular dimensions by ultrasound (jugular veins, cerebral and carotid arteries, vertebral arteries and veins, portal vein); (4) vascular dynamics by MRI (head/neck blood flow, cerebrospinal fluid pulsatility); (5) ocular measures (optical coherence tomography; intraocular pressure; 2-dimensional ultrasound including optic nerve sheath diameter, globe flattening, and retina-choroid thickness; Doppler ultrasound of ophthalmic and retinal arteries and veins); (6) cardiac variables by ultrasound (inferior vena cava, tricuspid flow and tissue Doppler, pulmonic valve, stroke volume, right heart dimensions and function, four-chamber views); and (7) ICP measures (tympanic membrane displacement, otoacoustic emissions). Pre- and post-flight, acute head-down tilt will induce cephalad fluid shifts, whereas lower body negative pressure will oppose these shifts. Controlled Mueller maneuvers will manipulate cardiovascular variables. Through interventions applied before, during, and after flight, we intend to fully evaluate the relationship between fluid shifts and the VIIP syndrome. Discussion. Ten subjects have consented to participate in this experiment, including the recent One-Year Mission crewmembers, who have recently completed R plus180 testing; all other subjects have completed pre-flight testing. Preliminary results from the One-Year Mission crewmembers will be presented, including measures of ocular structure and function, vascular dimensions, fluid distribution, and non-invasive estimates of intracranial pressure.

Stenger, M. B.↗
NASA NTRS2015

Fatigue in U.S. Astronauts Onboard the International Space Station: Environmental factors, Operational Impacts, and Implementation of Countermeasures

Crewmembers have experienced fatigue for reasons similar to military deployments. Astronauts experience psychological stressors such as: heavy workloads, extended duty periods, circadian misalignment, inadequate/ineffective sleep, distracting background noise, unexpected and variable mission schedules, unfavorable thermal control, unusual sleep environment with schedules that impinge on pre‐sleep periods.

Scheuring, R. A.↗
NASA NTRS2014

Fatigue in U.S. Astronauts Onboard the International Space Station: Environmental Factors, Operational Impacts, and Implementation of Countermeasures

Since 2000, US astronauts have been supporting missions up to a six month duration on the International Space Station (ISS). Crewmembers have experienced fatigue for reasons similar to military deployments. Astronauts experience psychological stressors such as heavy workloads, extended duty periods, circadian misalignment, inadequate/ineffective sleep, and loss of the environmental cues of a gravity environment. Complicating the psychological stressors are environmental factors; distracting background noise, unexpected and variable mission schedules, unfavorable thermal control, elevated CO2 levels, and an unusual sleep environment with schedules that impinge on pre‐sleep periods. Physiological contributors to poor sleep and fatigue include a cephalad fluid shift and back pain. Restful sleep is further challenged due to a lack of gravity‐related proprioceptive cues and need for restraints. The term "space fog" has been used by astronauts to describe a phenomenon of forgetfulness, slowed reaction time and transient confusion while trying to complete tasks. There is a distinct temporal correlation with arrival on the Space Station and the onset of slowed cognitive skills and a spontaneous resolution that may take up to 6 weeks. The Genesis of this phenomenon may be chronic fatigue secondary to transitioning from a planar environment to a 360deg microgravity perspective. Recently, countermeasures to improve sleep duration and quality in astronauts on the ISS have been instituted with moderate degrees of success as measured by self‐reaction time (psychomotor vigilance task testing), actigraphy, and subjective reports. Judicious use of stimulants and hypnotics, light therapy, controlled sleep periods and sleep shifting and reducing ambient CO2 levels are a few of the most promising countermeasures being used in space to improve sleep and reduce fatigue.

Scheuring, R. A.↗
NASA NTRS2009

Medical Operational Challenges in the Expedition 16 Landing and Recovery

On April 19, 2008 the crew of Expedition 16 left the International Space Station and returned to earth via their Soyuz TMA-11 capsule after 192 days on orbit. Their capsule experienced the second consecutive and third ballistic reentry in the last 10 TMA recoveries and landed approximately 260 miles (420 km) from the prime landing site. Issues: The purpose of this presentation will be to describe, not only the typical medical operational challenges faced by Flight Surgeons recovering a long duration crew from space, but also address the unique challenges that existed with the Expedition 16 landing and crew recovery. Nominal Soyuz recovery challenges include remote recovery sites with crew exposures to sleep shifting and fatigue, dehydration, hypothermia and hyperthermia, and rotational, sustained, and impact g-forces. These environmental factors coupled with the patho-physiologic neuro-vestibular and orthostatic intolerance changes that occur secondary to the crews reintroduction into the earth s gravity field will be detailed. Additional challenges that were unique to this expedition included a ballistic reentry with higher g-loads, the presence of fire outside of the capsule on landing, a contingency medical event of a ground support personnel, and loss of communications with the crew just prior to landing and during recovery operations. Conclusions: In spite of these unique challenges the Russian Search and Rescue Forces and Medical Support personnel along with U.S. Medical Support performed well together. Possible improvements in training and coordination will be discussed.

Moynihan, S.↗
NASA NTRS2008

Data Mining Activities for Bone Discipline - Current Status

The disciplinary goals of the Human Research Program are broadly discussed. There is a critical need to identify gaps in the evidence that would substantiate a skeletal health risk during and after spaceflight missions. As a result, data mining activities will be engaged to gather reviews of medical data and flight analog data and to propose additional measures and specific analyses. Several studies are briefly reviewed which have topics that partially address these gaps in knowledge, including bone strength recovery with recovery of bone mass density, current renal stone formation knowledge, herniated discs, and a review of bed rest studies conducted at Ames Human Research Facility.

Sibonga, J. D.↗
NASA NTRS2008

Career Excess Mortality Risk from Diagnostic Radiological Exams Required for Crewmembers Participating in Long Duration Space Flight

NASA requires astronauts to undergo diagnostic x-ray examinations as a condition for their employment. The purpose of these procedures is to assess the astronaut s overall health and to diagnose conditions that could jeopardize the success of long duration space missions. These include exams for acceptance into the astronaut corps, routine periodic exams, as well as evaluations taken pre and post missions. Issues: According to NASA policy these medical examinations are considered occupational radiological exposures, and thus, are included when computing the astronaut s overall radiation dose and associated excess cancer mortality risk. As such, astronauts and administrators are concerned about the amount of radiation received from these procedures due to the possibility that these additional doses may cause astronauts to exceed NASA s administrative limits, thus disqualifying them from future flights. Methods: Radiation doses and cancer mortality risks following required medical radiation exposures are presented herein for representative male and female astronaut careers. Calculation of the excess cancer mortality risk was performed by adapting NASA s operational risk assessment model. Averages for astronaut height, weight, number of space missions and age at selection into the astronaut corps were used as inputs to the NASA risk model. Conclusion: The results show that the level of excess cancer mortality imposed by all required medical procedures over an entire astronaut s career is approximately the same as that resulting from a single short duration space flight (i.e. space shuttle mission). In short the summation of all medical procedures involving ionizing radiation should have no impact on the number of missions an astronaut can fly over their career. Learning Objectives: 1. The types of diagnostic medical exams which astronauts are subjected to will be presented. 2. The level of radiation dose and excess mortality risk to the average male and female astronaut will be presented.

Dodge, C. W.↗
NASA NTRS2002

Percutaneous aspiration of fluid for management of peritonitis in space

BACKGROUND: As a medical emergency that can affect even well-screened, healthy individuals, peritonitis developing during a long-duration space exploration mission may dictate deviation from traditional clinical practice due to the absence of otherwise indicated surgical capabilities. Medical management can treat many intra-abdominal processes, but treatment failures are inevitable. In these circumstances, percutaneous aspiration under sonographic guidance could provide a "rescue" strategy. Hypothesis: Sonographically guided percutaneous aspiration of intra-peritoneal fluid can be performed in microgravity. METHODS: Investigations were conducted in the microgravity environment of NASA's KC-135 research aircraft (0 G). The subjects were anesthetized female Yorkshire pigs weighing 50 kg. The procedures were rehearsed in a terrestrial animal lab (1 G). Colored saline (500 mL) was introduced through an intra-peritoneal catheter during flight. A high-definition ultrasound system (HDI-5000, ATL, Bothell, WA) was used to guide a 16-gauge needle into the peritoneal cavity to aspirate fluid. RESULTS: Intra-peritoneal fluid collections were easily identified, distinct from surrounding viscera, and on occasion became more obvious during weightless conditions. Subjectively, with adequate restraint of the subject and operators, the procedure was no more demanding than during the 1-G rehearsals. CONCLUSIONS: Sonographically guided percutaneous aspiration of intra-peritoneal fluid collections is feasible in weightlessness. Treatment of intra-abdominal inflammatory conditions in spaceflight might rely on pharmacological options, backed by sonographically guided percutaneous aspiration for the "rescue" of treatment failures. While this risk mitigation strategy cannot guarantee success, it may be the most practical option given severe resource limitations.

Non-NASA Center↗
NASA NTRS2001

Endoscopic surgery in weightlessness: the investigation of basic principles for surgery in space

BACKGROUND: Performing a surgical procedure in weightlessness, also called 0-gravity (0-g), has been shown to be no more difficult than in a 1-g environment if the requirements for the restraint of the patient, operator, surgical hardware, are observed. The performance of laparoscopic and thorascopic procedures in weightlessness, if feasible, would offer several advantages over the performance of an open operation. Concerns about the feasibility of performing minimally invasive procedures in weightlessness have included impaired visualization from the absence of gravitational retraction of the bowel (laparoscopy) or thoracic organs (thoracoscopy) as well as obstruction and interference from floating debris such as blood, pus, and irrigation fluid. The purpose of this study was to determine the feasibility of performing laparoscopic and thorascopic procedures and the degree of impaired surgical endoscopic visualization in weightlessness. METHODS: From 1993 to 2000, laparoscopic and thorascopic procedures were performed on 10 anesthetized adult pigs weighing approximately 50 kg in the National Aeronautics and Space Administration (NASA) Microgravity Program using a modified KC-135 airplane. The parabolic simulation system for advanced life support was used in this project, and 20 to 40 parabolas were used for laparoscopic or thorascopic investigation, each containing approximately 30 s of 0-g alternating with 2-g pullouts. The animal model was restrained in the supine position on a floor-level Crew Medical Restraint System, and the abdominal cavity was insufflated with carbon dioxide. The intraabdominal and intrathoracic anatomy was visualized in the 1-g, 0-g, and 2-g periods of parabolic flight. Bleeding was created in the animals, and the behavior of the blood in the abdominal and thoracic cavities was observed. In the thoracic cavity, gas insufflation and mechanical retraction was used at times unilaterally to decrease pulmonary ventilation enough to increase the thoracic domain. RESULTS: Visualization was improved in laparoscopy, from tethering of the bowel by the elastic mesentery, and from the strong tendency for debris and blood to adhere to the abdominal wall because of surface tension forces. The lack of adequate thoracic domain made thorascopy more difficult. Fluid in the thoracic cavity did not impair visualization because the fluid at 0-g does not loculate posteriorly, but disperses along the thoracic wall and mediastinal reflections. CONCLUSIONS: Performing minimally invasive procedures instead of open surgical procedures in a weightless environment has theoretical advantages, especially in the ability to prevent cabin atmosphere contamination from surgical fluids (blood, pus, irrigation). Visualization will become more important and practical as the endoscopic hardware is miniaturized from its current form, as endoscopic technology becomes more advanced, and as more surgically capable medical crew officers are present in future long-duration space exploration missions.

short duration↗
NASA NTRS1992

A prototype Crew Medical Restraint System (CMRS) for Space Station Freedom

The Crew Medical Restrain System (CMRS) is a prototype system designed and developed for use as a universally deployable medical restraint/workstation on Space Station Freedom (SSF), the Shuttle Transportation System (STS), and the Assured Crew Rescue Vehicle (ACRV) for support of an ill or injured crewmember requiring stabilization and transportation to Earth. The CMRS will support all medical capabilities of the Health Maintenance Facility (HMF) by providing a restraint/interface system for all equipment (advance life support packs, defibrillator, ventilator, portable oxygen supply, IV pump, transport monitor, transport aspirator, and intervenous fluids delivery system) and personnel (patient and crew medical officers). It must be functional within the STS, ACRV, and all SSF habitable volumes. The CMRS will allow for medical capabilities within CPR, ACLS and ATLS standards of care. This must all be accomplished for a worst case transport time scenario of 24 hours from SSF to a definitive medical care facility on Earth. A presentation of the above design prototype with its subsequent one year SSF/HMF and STS/ACRV high fidelity mock-up ground based simulation testing will be given. Also, parabolic flight and underwater Weightless Test Facility evaluations will be demonstrated for various medical contingencies. The final design configuration to date will be discussed with future space program impact considerations.

Johnston, S. L.↗
NASA NTRS1992

A surgical support system for Space Station Freedom

Surgical techniques in microgravity are being developed for the Health Maintenance Facility (HMF) on Space Station Freedom (SSF). This will be a presentation of the proposed surgical capabilities and ongoing hardware and procedural investigations. Methods: Procedures and prototype hardware, which include a medical restraint system, a surgical overhead isolation canopy, a suction device, and a regional laminar flow device were evaluated. This was accomplished by realistic sterile surgical simulations involving both mannequins and animals during KC-135 parabolic flight and in a high fidelity ground based HMF mockup. Results: Animal surgery in the environment of microgravity allowed the observation of unique arterial and venous bleeding characteristics for the first time. The ability to control bleeding and to prevent cabin atmosphere contamination was also demonstrated. Conclusions: The procedures and prototype hardware tested provided valuable information and should be investigated and developed further. The use of standard surgical techniques are possible in microgravity if the principles of personnel and supply restraint and operative field containment are adhered to.

Campbell, M. R.↗