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Barophysiology and Biophysics

Decompression is an important aspect of extravehicular activity (EVA). Errors can result in decompression sickness (DCS) if the protective measures are too liberal, while valuable on-orbit time is dissipated in prophylactic methodologies that are excessively conservative. Nucleation is an important consideration in many natural events, and its control is very important in many industrial procedures. The amount of Extravehicular Activity (EVA) that will be required during the construction of the International Space Station exceeds all of the other activity combined. The requirements in astronaut time and consumables (breathing oxygen and air) will be considerable. In an attempt to mitigate these requirements, Project ARGO was investigated in 1990 to investigate the effects of gravitational forces on the musculoskeletal system. This work has led to the present plans for the reduction of prebreathe duration. Over the past decade, research has been directed towards an understanding of the biophysical basis of the formation and growth of the decompression gas phase with the goal of improving the efficiency of the EVA process. In the past, we have direct work towards a more complete understanding of gas bubble formation and growth and exercise-enhanced washout during oxygen prebreathe.

Powell, Michael R.↗

Results of a 3-day Pilot Study to Validate Planetary Prebreathe Protocols Using a 56.5 kPa 34% O2, 66% N2 Saturation Cabin Atmosphere

INTRODUCTION: Apollo missions used 100% O2 cabin atmospheres which effectively eliminated the risk of decompression sickness (DCS) during extravehicular activities (EVAs, ‘spacewalks’); however, this atmosphere presented a flammability risk that is no longer acceptable to NASA. Denitrogenation prebreathe protocols used to mitigate DCS risk for Space Shuttle and International Space Station EVAs are validated for the microgravity environment, but the significantly increased risk of DCS during equivalent ambulatory surface EVAs make these protocols inapplicable to planetary/Lunar missions. An “exploration atmosphere” of 56.5 kPa (8.2 psia), 34% O2, 66% N2 has been recommended by NASA for future Moon and Mars missions as a compromise that balances subsequent pre-EVA prebreathe duration, hypoxia, and flammability risk, assuming a 29.6 kPa (4.3 psi) spacesuit. Prebreathe validation studies was initiated utilizing a three-story 6m diameter hypobaric chamber at NASA’s Johnson Space Center. Here, we report the results of a 3-day human-in-the-loop system checkout. METHODS: Six volunteers acclimated to the 56.6kPa/34% O2 66% N2 environment for 48hrs prior to conducting a 20-minute prebreathe and a 6-hour simulated EVA at 34kPa/85% O2 / 15% N2. The EVA simulation was designed to include tasks that are physically and ergonomically representative of future planetary EVAs. Decompression stress was evaluated by serial doppler and echocardiographs, as well as by clinical features of DCS signs/symptoms. RESULTS AND DISCUSSION: Preliminary data analysis noted venous gas emboli (VGE) in 3 of 6 subjects, with peak Grade II VGE by Doppler and peak E-B score of 5 by cardiac ultrasonography. No volunteers were diagnosed with DCS during this initial test. No acute hypoxic symptoms were noted. Musculoskeletal and gastrointestinal complaints were noted, likely associated with the exercise load and the food system. Validation of exploration prebreathe protocols has since been initiated with an 11-day saturation test using the same facility and protocol.

Alejandro Garbino↗

Minimum pressure for a zero-prebreathe pressure suit

There are two current approaches to reducing the risk of decompression sickness during repeated extravehicular activity (EVA) without prebreathing 100 percent oxygen. One approach suggests the use of different pressures in the transfer vehicle, the station, and the suit. The other would use advanced pressure-suit technology to build a suit that will make different pressures unnecessary provided the bends-free suit pressure is reasonable and can be readily determined. Research at the USAF School of Aerospace Medicine since November 1982 has been directed at determining this suit pressure using human subjects at simulated altitudes of 16,500 to 10,000 feet (7.8 to 10 psia). An earlier report of this ongoing research showed that bends is not totally eliminated at 7.8 psia. The present study is a continuation of this effort to define a 'bends-free' suit pressure with the initial results suggesting that this pressure begins at around 9.5 psia (from a 14.7 psia station).

Krutz, R. W., Jr.↗

Space Flight Decompression Sickness Contingency Plan

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.

Dervay, Joseph↗

Exploration Health Risks: Probabilistic Risk Assessment

Maintenance of human health on long-duration exploration missions is a primary challenge to mission designers. Indeed, human health risks are currently the largest risk contributors to the risks of evacuation or loss of the crew on long-duration International Space Station missions. We describe a quantitative assessment of the relative probabilities of occurrence of the individual risks to human safety and efficiency during space flight to augment qualitative assessments used in this field to date. Quantitative probabilistic risk assessments will allow program managers to focus resources on those human health risks most likely to occur with undesirable consequences. Truly quantitative assessments are common, even expected, in the engineering and actuarial spheres, but that capability is just emerging in some arenas of life sciences research, such as identifying and minimize the hazards to astronauts during future space exploration missions. Our expectation is that these results can be used to inform NASA mission design trade studies in the near future with the objective of preventing the higher among the human health risks. We identify and discuss statistical techniques to provide this risk quantification based on relevant sets of astronaut biomedical data from short and long duration space flights as well as relevant analog populations. We outline critical assumptions made in the calculations and discuss the rationale for these. Our efforts to date have focussed on quantifying the probabilities of medical risks that are qualitatively perceived as relatively high risks of radiation sickness, cardiac dysrhythmias, medically significant renal stone formation due to increased calcium mobilization, decompression sickness as a result of EVA (extravehicular activity), and bone fracture due to loss of bone mineral density. We present these quantitative probabilities in order-of-magnitude comparison format so that relative risk can be gauged. We address the effects of conservative and nonconservative assumptions on the probability results. We discuss the methods necessary to assess mission risks once exploration mission scenarios are characterized. Preliminary efforts have produced results that are commensurate with earlier qualitative estimates of risk probabilities in this and other operational contexts, indicating that our approach may be usefully applied in support of the development of human health and performance standards for long-duration space exploration missions. This approach will also enable mission-specific probabilistic risk assessments for space exploration missions.

Rhatigan, Jennifer↗

Piloted Ignition Delay of PMMA in Space Exploration Atmospheres

In order to reduce the risk of decompression sickness associated with extravehicular activity (EVA), NASA is designing the next generation of exploration vehicles and habitats with a different cabin environment than used previously. The proposed environment uses a total cabin pressure of 52.7 to 58.6 kPa with an oxygen concentration of 30 to 34% by volume and was chosen with material flammability in mind. Because materials may burn differently under these conditions and there is little information on how this new environment affects the flammability of the materials onboard, it is important to conduct material flammability experiments at the intended exploration atmosphere. One method to evaluate material flammability is by its ease of ignition. To this end, piloted ignition delay tests were conducted in the Forced Ignition and Spread Test (FIST) apparatus subject to this new environment. In these tests, polymethylmethacylate (PMMA) was exposed to a range of oxidizer flow velocities and externally applied heat fluxes. Tests were conducted for a baseline case of normal pressure and oxygen concentration, low pressure (58.6 kPa) with normal oxygen (21%), and low pressure with 32% oxygen concentration conditions to determine the individual effect of pressure and the combined effect of pressure and oxygen concentration on the ignition delay. It was found that reducing the pressure while keeping the oxygen concentration at 21% reduced the ignition time by 17% on average. Increasing the oxygen concentration at low pressures reduced the ignition time by an additional 10%. It was also noted that the critical heat flux for ignition decreases at exploration atmospheres. These results show that tests conducted in standard atmospheric conditions will underpredict the ignition of materials intended for use on spacecraft and that, at these conditions, materials are more susceptible to ignition than at current spacecraft atmospheres.

McAllister, Sara↗

Effects of the 8 psia / 32% O2 Atmosphere on the Human in the Spaceflight Environment

Extravehicular activity (EVA) is at the core of a manned space exploration program. There are elements of exploration that may be safely and effectively performed by robots, but there are critical elements of exploration that will require the trained, assertive, and reasoning mind of a human crewmember. To effectively use these skills, NASA needs a safe, effective, and efficient EVA component integrated into the human exploration program. The EVA preparation time should be minimized and the suit pressure should be low to accommodate EVA tasks without undue fatigue, physical discomfort, or suit-related trauma. Commissioned in 2005, the Exploration Atmospheres Working Group (EAWG) had the primary goal of recommending to NASA an internal environment that allowed efficient and repetitive EVAs for missions that were to be enabled by the former Constellation Program. At the conclusion of the EAWG meeting, the 8.0 psia and 32% oxygen (O2) environment were recommended for EVA intensive phases of missions. As a result of selecting this internal environment, NASA gains the capability for efficient EVA with low risk of decompression sickness (DCS), but not without incurring additional negative stimulus of hypobaric hypoxia to the already physiologically challenging spaceflight environment. This paper provides a literature review of the human health and performance risks associated with the 8 psia/32% O2 environment. Of most concern are the potential effects on the central nervous system including increased intracranial pressure, visual impairment, sensorimotor dysfunction, and oxidative damage. Other areas of focus include validation of the DCS mitigation strategy, incidence and treatment of acute mountain sickness (AMS), development of new exercise countermeasures protocols, effective food preparation at 8 psia, assurance of quality sleep, and prevention of suit-induced injury. As a first effort, the trade space originally considered in the EAWG was re-evaluated looking for ways to decrease the hypoxic dose by further enriching the O2% or increasing the pressure. After discussion with the NASA engineering and materials community, it was determined that the O2 could be enriched from 32% to 34% and the pressure increased from 8.0 to 8.2 psia without significant penalty. These two small changes increase alveolar O2 pressure by 11 mmHg, which is expected to significantly benefit crewmembers. The 8.2/34 environment (inspired O2 pressure = 128 mmHg) is also physiologically equivalent to the staged decompression atmosphere of 10.2 psia / 26.5% O2 (inspired O2 pressure = 127 mmHg) used on 34 different shuttle missions for approximately a week each flight. Once decided, the proposed internal environment, if different than current experience, should be evaluated through appropriately simulated research studies. In many cases, the human physiologic concerns can be investigated effectively through integrated multi-discipline ground-based studies. Although missions proposing to use an 8.2/34 environment are still years away, it is recommended that these studies begin early enough to ensure that the correct decisions pertaining to vehicle design, mission operational concepts, and human health countermeasures are appropriately informed.

Environmental control↗

Evidence Report: Risk of Hypobaric Hypoxia from the Exploration Atmosphere

Extravehicular activity (EVA) is at the core of a manned space exploration program. Some elements of exploration may be safely and effectively performed by robots, but certain critical elements will require the trained, assertive, and reasoning mind of a human crewmember. To effectively use these skills, NASA needs a safe, effective, and efficient EVA component integrated into the human exploration program. The EVA preparation time should be minimized and the suit pressure should be low to accommodate EVA tasks without causing undue fatigue, physical discomfort, or suit-related trauma. Commissioned in 2005, the Exploration Atmospheres Working Group (EAWG) had the primary goal of recommending to NASA an internal environment that allowed efficient and repetitive EVAs for missions that were to be enabled by the former Constellation Program. At the conclusion of the EAWG meeting, the 8.0 psia and 32% oxygen (O2) environment were recommended for EVA-intensive phases of missions. After re-evaluation in 2012, the 8/32 environment was altered to 8.2 psia and 34% O2 to reduce the hypoxic stress to a crewmember. These two small changes increase alveolar O2 pressure by 11 mmHg, which is expected to significantly benefit crewmembers. The 8.2/34 environment (inspired O2 pressure = 128 mmHg) is also physiologically equivalent to the staged decompression atmosphere of 10.2 psia / 26.5% O2 (inspired O2 pressure = 127 mmHg) used on 34 different shuttle missions for approximately a week each flight. As a result of selecting this internal environment, NASA gains the capability for efficient EVA with low risk of decompression sickness (DCS), but not without incurring the additional negative stimulus of hypobaric hypoxia to the already physiologically challenging spaceflight environment. This report provides a review of the human health and performance risks associated with the use of the 8.2 psia / 34% O2 environment during spaceflight. Of most concern are the potential effects on the central nervous system (CNS), including increased intracranial pressure, visual impairment, sensorimotor dysfunction, and oxidative damage. Other areas of focus include validation of the DCS mitigation strategy, incidence and treatment of transient acute mountain sickness (AMS), development of new exercise countermeasure protocols, effective food preparation at 8.2 psia, assurance of quality sleep, and prevention of suit-induced injury. Although missions proposing to use an 8.2/34 environment are still years away, it is recommended that these studies begin early enough to ensure that the correct decisions pertaining to vehicle design, mission operational concepts, and human health countermeasures are appropriately informed.

Norcross, Jason R.↗

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↗

Evidence Report: Risk of Decompression Sickness (DCS)

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.

Conkin, Johnny↗

Role of Inflammatory Reponse in Experimental Decompression Sickness

Decompression to altitude can result in gas bubble formation both in tissues and in the systemic veins. The venous gas emboli (VGE) are often monitored during decompression exposures to assess risk for decompression sickness (DCS). Astronauts are at risk for DCS during extravehicular activities (EVA), where decompression occurs from the Space Shuttle or Space Station atmospheric pressure of 14.7 pounds per square inch (PSI) to that of the space suit pressure of 4.3 PSI. DCS symptoms include diffuse pain, especially around joints, inflammation and edema. Pathophysiological effects include interstitial inflammatory responses and recurring injury to the vascular endothelium. Such responses can result in vasoconstriction and associated hemodynamic changes.The granulocyte cell activation and chemotaxin release results in the formation of vasoactive and microvascular permeability altering mediators, especially from the lungs which are the principal target organ for the venous bubbles, and from activated cells (neutrophils, platelets, macrophages). Such mediators include free arachidonic acid and the byproducts of its metabolism via the cyclooxygenase and lipoxygenase pathways (see figure). The cyclooxygenase pathway results in formation of prostacyclin and other prostaglandins and thromboxanes that cause vasoconstriction, bronchoconstriction and platelet aggregation. Leukotrienes produced by the alternate pathway cause pulmonary and bronchial smooth muscle contraction and edema. Substances directly affecting vascular tone such as nitric oxide may also play a role in the respose to DCS. We are studying the role and consequent effects of the release inflammatory bioactive mediators as a result of DCS and VGE. More recent efforts are focused on identifying the effects of the body's circadian rhythm on these physiological consequences to decompression stress. al

Butler, B. D.↗

Evaluation of Planetary Extravehicular Activity Prebreathe Protocols using a 56.5 kPa, 34% O2, 66% N2 Saturation Cabin Atmosphere in an 11-day Hypobaric Hypoxia Study

INTRODUCTION: Apollo missions used 100% O2 cabin atmospheres which effectively eliminated the risk of decompression sickness (DCS) during Lunar extravehicular activities (EVAs, ‘spacewalks’); however, this atmosphere presented a flammability risk that is no longer acceptable to NASA. Denitrogenation prebreathe protocols used to mitigate DCS risk for Space Shuttle and International Space Station EVAs are validated for the microgravity environment, but the significantly increased risk of DCS during equivalent ambulatory surface EVAs make these protocols inapplicable to planetary/Lunar missions. A cabin/vehicle “Exploration Atmosphere” of 56.5 kPa (8.2 psia), 34% O2, 66% N2 has been recommended by NASA for future Moon and Mars missions as a compromise that balances subsequent pre-EVA prebreathe duration, hypoxia, and flammability risk, assuming a 29.6 kPa (4.3 psi) spacesuit. Prebreathe validation studies were initiated utilizing a three-story 6m diameter hypobaric chamber at NASA’s Johnson Space Center. Here, we report the results of a 11-day human-in-the-loop system checkout. METHODS: Six volunteers lived in a hyboparic chamber for 11 days with an ‘exploration atmosphere’ of 56.6kPa/34% O2 66% N2. Subjects acclimated to the exploration atmosphere for 48hrs and thereafter participated in five 6-hour simulated EVAs at 34kPa/85% O2 / 15% N2 over the course of 11 days. Prior to each simulated EVA, subjects underwent a 20-minute prebreathe at 85% O2. The EVA simulation was designed to include tasks that are physically and ergonomically representative of future planetary EVAs, proportionate to the subject’s VO2max. Decompression stress was evaluated during the simulated EVA by serial doppler and echocardiographs alternating every 15min, as well as clinical monitoring for DCS signs/symptoms. RESULTS AND DISCUSSION: Venous gas emboli (VGE) were present in 3 of 6 subjects during EVAs, with peak Grade II VGE as evaluated by Doppler and a peak Eftedal-Brubakk score of 5 by cardiac ultrasonography. Two cases of DCS were diagnosed during the 11-day test chamber. No acute hypoxic symptoms were noted. Musculoskeletal and gastrointestinal complaints were noted, likely associated with the exercise load and the food system. Two cases of DCS (8%) does not cross either accept or reject pre-test criterion, so an additional study is planned for 2023 to meet our pre-test thresholds.

Alejandro Garbino↗

The effect of simulated weightlessness on hypobaric decompression sickness

BACKGROUND: A discrepancy exists between the incidence of ground-based decompression sickness (DCS) during simulated extravehicular activity (EVA) at hypobaric space suit pressure (20-40%) and crewmember reports during actual EVA (zero reports). This could be due to the effect of gravity during ground-based DCS studies. HYPOTHESIS: At EVA suit pressures of 29.6 kPa (4.3 psia), there is no difference in the incidence of hypobaric DCS between a control group and group exposed to simulated weightlessness (supine body position). METHODS: Male subjects were exposed to a hypobaric pressure of 29.6 kPa (4.3 psi) for up to 4 h. The control group (n = 26) pre-oxygenated for 60 min (first 10 min exercising) before hypobaric exposure and walking around in the altitude chamber. The test group (n = 39) remained supine for a 3 h prior to and during the 60-min pre-oxygenation (also including exercise) and at hypobaric pressure. DCS symptoms and venous gas emboli (VGE) at hypobaric pressure were registered. RESULTS: DCS occurred in 42% in the control and in 44% in simulated weightlessness group (n.s.). The mean time for DCS to develop was 112 min (SD +/- 61) and 123 min (+/- 67), respectively. VGE occurred in 81% of the control group subjects and in 51% of the simulated weightlessness subjects (p = 0.02), while severe VGE occurred in 58% and 33%, respectively (p = 0.08). VGE started after 113 min (+/- 43) in the control and after 76 min (+/- 64) in the simulated weightlessness group. CONCLUSIONS: No difference in incidence of DCS was shown between control and simulated weightlessness conditions. VGE occurred more frequently during the control condition with bubble-releasing arm and leg movements.

NASA Discipline Environmental Health↗

Transcranial Doppler ultrasound and the etiology of neurologic decompression sickness during altitude decompression

The presence of gas bubbles in the arterial circulation can occur from iatrogenic mishaps, cardiopulmonary bypass devices, or following decompression, e.g., in deep-sea or SCUBA diving or in astronauts during extravehicular activities (EVA). We have examined the pathophysiology of neurological decompression sickness in human subjects who developed a large number of small gas bubbles in the right side of the heart as a result of hypobaric exposures. In one case, gas bubbles were detected in the middle cerebral artery (MCA) and the subject developed neurological symptoms; a 'resting' patent foramen ovalae (PFO) was found upon saline contrast echocardiography. A PFO was also detected in another individual who developed Spencer Grade 4 precordial Doppler ultrasound bubbles, but no evidence was seen of arterialization of bubbles upon insonation of either the MCA or common carotid artery. The reason for this difference in the behavior of intracardiac bubbles in these two individuals is not known. To date, we have not found evidence of right-to-left shunting of bubbles through pulmonary vasculature. The volume of gas bubbles present following decompression is examined and compared with the number arising from saline contrast injection. The estimates are comparable.

Norfleet, W. T.↗

Health and Safety Benefits of Small Pressurized Suitport Rovers as EVA Surface Support Vehicles

Pressurized safe-haven providing SPE protection and decompression sickness (DCS) treatment capabilities within 20 mins at all times. Up to 50% reduction in time spent in EVA suits (vs. Unpressurized Rovers) for equal or greater Boots-on-Surface EVA exploration time. Reduces suit-induced trauma and provides improved options for nutrition, hydration, and waste-management. Time spent inside SPR during long translations may be spent performing resistive and cardiovascular exercise. Multiple shorter EVAs versus single 8 hr EVAs increases DCS safety and decreases prebreathe requirements. SPRs also offer many potential operational, engineering and exploration benefits not addressed here.

Gernhardt, Michael L.↗

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.

Conkin, Johnny↗