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NASA NTRS1993

Joint pain and Doppler-detectable bubbles in altitude (Hypobaric) decompression

The observation that altitude decompression sickness (DCS) is associated with pain in the lower extremities is not new, although it is not a consistent finding. DCS in divers is generally in the upper body, an effect often attributed to non-loading of the body while immersed. In caisson workers, DCS is reported more in the lower extremities. Surprisingly, many researchers do not mention the location of DCS joint pain, apparently considering it to be random. This is not the case for the tissue ratios encountered in studying decompression associated with simulated EVA. In NASA/JSC tests, altitude DCS generally presented first in either the ankle, knee, or hip (83 percent = 73/88). There was a definite statistical relation between the maximum Spencer precordial Doppler Grade and the incidence of DCS in the extremity, although this is not meant to imply a casual relation between circulating gas bubbles and joint pain. The risk of DCS with Grade 4 was considerably higher than that of Grades 0 to 3. The DCS risk was independent of the 'tissue ratio.' There was a predominance of lower extremity DCS even when exercise was performed with the upper body. The reason for these locations we hypothesize to be attributed to the formation of tissue gas micronuclei from kinetic and tensile forces (stress-assisted nucleation) and are the result of the individuals ambulating in a 1g environment. Additionally, since these showers of Doppler bubbles can persist for hours, it is difficult to imagine that they are emanating solely from tendons and ligaments, the supposed site of joint pain. This follows from Henry's law linking the volume of joint tissue (the solvent) and the solubility coefficient of inert gas; there is volumetrically insufficient connective tissue to produce the prolonged release of gas bubbles. If gas bubbles are spawned and released from connective tissue, their volume is increased by those from muscle tissue. Therefore, the nexus between Doppler-detectable gas bubbles and joint-pain decompression sickness is essentially a statistical, rather than a direct, one.

Powell, Michael R.↗
NASA NTRS1993

Breathing 100 percent oxygen compared with 50 percent oxygen:50 percent nitrogen reduces altitude-induced venous gas emboli

The study investigates effects of 40 zero-prebreathe decompressions of male subjects to 8.3-6.8 psia for 6 h while they were breathing 100 percent oxygen and performing moderate exercise. No decompression sickness (DCS) symptoms were observed. Severe venous gas emboli (VGE) were not detected at 8.3 psia, but were present during 10, 20, and 40 percent of the exposures at 7.8, 7.3, and 6.8 psia, respectively. Zero-prebreathe decompression while breathing 100 percent oxygen results in significantly lower VGE and DCS risk levels than while breathing a 50:50 mix. It is shown that 7.3 psia EVA pressure suits with 100 percent oxygen should be safer than 8.3 psia suits with a 50:50 mix.

Webb, James T.↗
NASA NTRS2016

Initial Incidence of White Matter Hyperintensities on MRI in Astronauts

Introduction: Previous literature has described the increase in white matter hyperintensity (WMH) burden associated with hypobaric exposure in the U-2 and altitude chamber operating personnel. Although astronauts have similar hypobaric exposure pressures to the U2 pilot population, astronauts have far fewer exposures and each exposure would be associated with a much lower level of decompression stress due to rigorous countermeasures to prevent decompression sickness. Therefore, we postulated that the WMH burden in the astronaut population would be less than in U2 pilots. Methods: Twenty-one post-flight de-identified astronaut MRIs (5 mm slice thickness FLAIR sequences) were evaluated for WMH count and volume. The only additional data provided was an age range of the astronauts (43-57) and if they had ever performed an EVA (13 yes, 8 no). Results: WMH count in these 21 astronaut MRI was 21.0 +/- 24.8 (mean+/- SD) and volume was 0.382 +/- 0.602 ml, which was significantly higher than previously published results for the U2 pilots. No significant differences between EVA and no EVA groups existed. Age range of astronaut population is not directly comparable to the U2 population. Discussion: With significantly less frequent (sometimes none) and less stressful hypobaric exposures, yet a much higher incidence of increased WMH, this indicates the possibility of additional mechanisms beyond hypobaric exposure. This increase unlikely to be attributable just to the differences in age between astronauts and U2 pilots. Forward work includes continuing review of post-flight MRI and evaluation of pre to post flight MRI changes if available. Data mining for potential WMH risk factors includes collection of age, sex, spaceflight experience, EVA hours, other hypobaric exposures, hyperoxic exposures, radiation, high performance aircraft experience and past medical history. Finally, neurocognitive and vision/eye results will be evaluated for any evidence of impairment linked to increased WMH.

Norcross, Jason↗
NASA NTRS1990

Threshold altitude resulting in decompression sickness

A review of case reports, hypobaric chamber training data, and experimental evidence indicated that the threshold for incidence of altitude decompression sickness (DCS) was influenced by various factors such as prior denitrogenation, exercise or rest, and period of exposure, in addition to individual susceptibility. Fitting these data with appropriate statistical models makes it possible to examine the influence of various factors on the threshold for DCS. This approach was illustrated by logistic regression analysis on the incidence of DCS below 9144 m. Estimations using these regressions showed that, under a noprebreathe, 6-h exposure, simulated EVA profile, the threshold for symptoms occurred at approximately 3353 m; while under a noprebreathe, 2-h exposure profile with knee-bends exercise, the threshold occurred at 7925 m.

Kumar, K. V.↗
NASA NTRS2024

Quantifying Risk to Improve Medical System Design for Long Duration Artemis Missions: A Demonstration of NASA's IMPACT Tradespace Analysis Tool

BACKGROUND NASA’s human exploration spaceflight missions to the Moon and Mars present unprecedented challenges for in-mission medical care. A greater distance from Earth will mean increased mission durations, communication delays, limited to no resupply opportunities, and constraints on the evacuation of ill or injured crew. Mass, volume, and power will be limited while higher demands will be placed on the crews to manage medical events. NASA’s Moon to Mars exploration strategy outlines increasingly complex Artemis missions both in terms of duration and operations. In these more challenging deep space missions, it is important to quantitatively estimate the human system risk attributable to medical conditions and use these estimates to advance medical system design. METHODS IMPACT (Informing Mission Planning via Analysis of Complex Tradespaces) is a probabilistic risk assessment (PRA) and tradespace analysis tool developed by NASA to advance exploration mission medical system design. IMPACT v1.0 includes a novel evidence library baselined to exploration environments; an expanded list of 119 medical conditions; a large increase in the number of medical resources and the flexibility of their use; and the ability for rapid and iterative analysis. Medical system risk estimates include loss of crew life, consideration of the need for return to definitive care (medical evacuation), and an estimate of crew time affected due to medical conditions. A notional long duration lunar orbit and lunar surface design reference mission (DRM) was chosen with a 4-astronaut crew to mimic a foundational exploration Artemis mission. The DRM profile includes outbound transit on Orion, Gateway space station rendezvous in lunar orbit, 6 months on the Lunar surface with extravehicular activity (EVA), return rendezvous with Gateway, and transit back to Earth. RESULTS/DISCUSSION: Overall, IMPACT successfully quantified medical risk and derived an optimal medical system to support crew on a long duration lunar mission. In this DRM, the calculated loss of crew life from a medical event was 0.008 events per mission, risk of potential need for evacuation was 0.30 events per mission, and cumulative crew time affected by medical conditions was 103 days. The medical conditions that most contributed to medical risk were decompression sickness, trauma, and respiratory failure. The conditions that had the largest effects on crew performance included musculoskeletal injuries and lunar dust exposure. The IMPACT-generated medical system included resources that target the most common and highest risk conditions and performed as expected. This demonstrates the value of the IMPACT tool in medical system design for human exploration spaceflight missions.

Arian Anderson↗
NASA NTRS1993

Hypobaric decompression prebreathe requirements and breathing environment

To reduce incidence of decompression sickness (DCS), prebreathing 100 percent oxygen to denitrogenate is required prior to hypobaric decompressions from a sea level pressure breathing environment to pressures lower than 350 mm Hg (20,000 ft; 6.8 psia). The tissue ratio (TR) of such exposures equals or exceeds 1.7; TR being the tissue nitrogen pressure prior to decompression divided by the total pressure after decompression (((0.781)(14.697))/6.758). Designing pressure suits capable of greater pressure differentials, lower TR's, and procedures which limit the potential for DCS occurrence would enhance operational efficiency. The current 10.2 psia stage decompression prior to extravehicular activity (EVA) from the Shuttle in the 100 percent oxygen, 4.3 psia suit, results in a TR of 1.65 and has proven to be relatively free of DCS. Our recent study of zero-prebreathe decompressions to 6.8 psia breathing 100 percent oxygen (TR = 1.66) also resulted in no DCS (N = 10). The level of severe, Spencer Grades 3 or 4, venous gas emboli (VGE) increased from 0 percent at 9.5 psia to 40 percent at 6.8 psia yielding a Probit curve of VGE risk for the 51 male subjects who participated in these recent studies. Earlier, analogous decompressions using a 50 percent oxygen, 50 percent nitrogen breathing mixture resulted in one case of DCS and significantly higher levels of severe VGE, e.g., at 7.8 psia, the mixed gas breathing environment resulted in a 56 percent incidence of severe VGE versus 10 percent with use of 100 percent oxygen. The report of this study recommended use of 100 percent oxygen during zero-prebreathe exposure to 6.8 psia if such a suit could be developed. For future, long-term missions, we suggest study of the effects of decompression over several days to a breathing environment of 150 mmHg O2 and approximately 52 mmHg He as a means of eliminating DCS and VGE hazards during subsequent excursions. Once physiologically adapted to a 4 psia vehicle, base, or space station segment, crew members could use greatly simplified EVA suits with greater mobility and no prebreathe requirement.

Webb, James T.↗
NASA NTRS2007

Biomedical Support of U.S. Extravehicular Activity

The world's first extravehicular activity (EVA) was performed by A. A. Leonov on March 18, 1965 during the Russian Voskhod-2 mission. The first US EVA was executed by Gemini IV astronaut Ed White on June 3, 1965, with an umbilical tether that included communications and an oxygen supply. A hand-held maneuvering unit (HHMU) also was used to test maneuverability during the brief EVA; however the somewhat stiff umbilical limited controlled movement. That constraint, plus difficulty returning through the vehicle hatch, highlighted the need for increased thermal control and improved EVA ergonomics. Clearly, requirements for a useful EVA were interrelated with the vehicle design. The early Gemini EVAs generated requirements for suits providing micro-meteor protection, adequate visual field and eye protection from solar visual and infrared radiation, gloves optimized for dexterity while pressurized, and thermal systems capable of protecting the astronaut while rejecting metabolic heat during high workloads. Subsequent Gemini EVAs built upon this early experience and included development of a portable environmental control and life support systems (ECLSS) and an astronaut maneuvering unit. The ECLSS provided a pressure vessel and controller with functional control over suit pressure, oxygen flow, carbon dioxide removal, humidity, and temperature control. Gemini EVA experience also identified the usefulness of underwater neutral buoyancy and altitude chamber task training, and the importance of developing reliable task timelines. Improved thermal management and carbon dioxide control also were required for high workload tasks. With the Apollo project, EVA activity was primarily on the lunar surface; and suit durability, integrated liquid cooling garments, and low suit operating pressures (3.75 pounds per square inch absolute [psia] or 25.8 kilopascal [kPa],) were required to facilitate longer EVAs with ambulation and significant physical workloads with average metabolic rates of 1000 BTU/hr and peaks of up to 2200 BTU/hr. Mobility was further augmented with the Lunar Roving Vehicle. The Apollo extravehicular mobility unit (EMU) was made up of over 15 components, ranging from a biomedical belt for capturing and transmitting biomedical data, urine and fecal containment systems, a liquid cooling garment, communications cap, a modular portable life support system (PLSS), a boot system, thermal overgloves, and a bubble helmet with eye protection. Apollo lunar astronauts performed successful EVAs on the lunar surface from a 5 psia (34.4 kPa) 100% oxygen environment in the Lunar Lander. A maximum of three EVAs were performed on any mission. For Skylab a modified A7LB suit, used for Apollo 15, was selected. The Skylab astronaut life support assembly (ALSA) provided umbilical support through the life support umbilical (LSU) and used open loop oxygen flow, rather than closed-loop as in Apollo missions. Thermal control was provided by liquid water circulated by spacecraft pumps and electrical power also was provided from the spacecraft via the umbilical. The cabin atmosphere of 5 psia (34.4 kPa), 70% oxygen, provided a normoxic atmosphere and because of the very low nitrogen partial pressures, no special protocols were required to protect against decompression sickness (DCS) as was the case with the Apollo spacecraft with a 5 psi, 100% oxygen environment.

Gernhardt, Michael L.↗
NASA NTRSDate not supplied

Effects of Mild Hypobaric Hypoxia on Response From Mild Exercise in NASA Exploration Atmosphere Tests

INTRODUCTION: The NASA Exploration Atmosphere study aims to validate a new prebreathe protocol incorporating an alternate habitat atmosphere of 56.5 kPa (8.2psia), 34% O 2 , and 66% N 2 to control and mitigate decompression sickness risk associated with spaceflight extravehicular activities. This alternate atmosphere results in a mild hypoxic environment (PIO 2 of 128 mmHg) that may influence inhabitant physiological responses to exercise. Therefore, the responses to light exercise in relation to the mild hypobaric hypoxic environment were investigated. METHODS: Eight participants (4M/4F; age=38.3±9.0 yr; weight=76.0±13.1 kg; peak aerobic capacity [VO 2 pk]= 3.1±0.7 L/min) were exposed to a mild hypobaric hypoxic environment for 11 days in NASA’s 20-foot hypobaric chamber at Johnson Space Center. Participants alternated test days between a habitat atmosphere of 56.5 kPA/34% O 2 and simulated 6-hour EVA environment, 29.6 kPa/85% O 2 . Participants completed pre-mission graded VO 2 pk tests on a LODE cycle ergometer with ParvoMedics metabolic analyzer. Submaximal aerobic tests were performed pre and during the mission (10-minutes of exercise at a workload of 40% VO 2 pk).Pre-mission, performed submaximal exercise exposed to a breathing air mixture of, 18% O 2 and balance N 2 , to simulate the mildly hypoxic environment within the 20-foot chamber. Linear mixed models (fixed effect: test day; random effects: subject, age) were performed to determine whether physiological responses (oxygen uptake [VO 2 ], carbon dioxide production [VCO 2 ], ventilation [VE], oxygen saturation [SPO 2 ], heart rate [HR], respiratory exchange ratio [RER]) to submaximal exercise performed within the 20-foot hypobaric chamber every 2 days differed from the pre-mission (18% O 2 ) testing. Results are presented as estimated marginal means with lower and upper confidence limits, with significance set to 0.05. RESULTS AND DISCUSSION: Seven of eight participants completed the chamber study. Mixed models for VO 2 , VCO 2 , SpO 2 , HR, and RER indicated negligible impact of the mild hypoxic chamber environment compared to pre-mission testing (all p>0.05).Results for VE indicated a minor impact of chamber environment compared to pre-mission testing (37.0 L/min [30.8, 43.2]), with increased VE at test day 10 (40.4 L/min [34.2, 46.6]; p= 0.029).The aerobic performance data collected suggests limited physiologic responses to mild exercise when performed at normobaric hypoxia and hypobaric hypoxia.

B Siders↗
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 NTRS1987

The effect of exercise on venous gas emboli and decompression sickness in human subjects at 4.3 psia

The contribution of upper body exercise to altitude decompression sickness while at 4.3 psia after 3.5 or 4.0 hours of 100% oxygen prebreathing at 14.7 psia was determined by comparing the incidence and patterns of venous gas emboli (VGE), and the incidence of Type 1 decompression sickness (DCS) in 43 exercising male subjects and 9 less active male Doppler Technicians (DT's). Each subject exercised for 4 minutes at each of 3 exercise stations while at 4.3 psia. An additional 4 minutes were spent monitoring for VGE by the DT while the subject was supine on an examination cot. In the combined 3.5 and 4.0 hour oxygen prebreathe data, 13 subjects complained of Type 1 DCS compared to 9 complaints from DT's. VGE were detected in 28 subjects compared to 14 detections from DT's. A chi-square analysis of proportions showed no statistically significantly difference in the incidence of Type 1 DCS or VGE between the two groups; however, the average time to detect VGE and to report Tyep 1 DCS symptoms were statistically different. It was concluded that 4 to 6 hours of upper body exercise at metabolic rates simulating EVA metabolic rates hastens the initial detection of VGE and the time to report Type 1 DCS symptoms as compared to DT's.

Conkin, Johnny↗
NASA NTRSDate not supplied

Habitability Assessments And Lessons-learned From 3-day And 11-day Enriched Oxygen Hypobaric Chamber Tests At NASA Johnson Space Center

INTRODUCTION: Decompression sickness (DCS) is a risk to the health and performance of astronauts and high-altitude aircrew. Tolerance to flammability, hypoxia, prebreathe duration, and DCS risk varies across different organizations, vehicles, suits, and destinations, necessitating a variety of DCS risk mitigation approaches. Existing models of altitude DCS risk are often insufficient to enable accurate risk-informed decisions during hardware development, mission planning, and flight operations. METHODS: NASA completed outfitting of a dedicated facility at Johnson Space Center to support testing of up to eight human subjects for multiple days in hypobaric and enriched oxygen atmospheres. The primary purpose of the testing capability is validation of DCS risk mitigation protocols for Artemis missions to the Moon; however, it will also support development and validation of a generalizable altitude DCS risk estimation tool. A 3-day and an 11-day prebreathe validation test were completed in 2022, each with 8 human subjects living at 56.5 kPa (8.2 psia), 34% O2, 66% N2, with 5 simulated EVAs performed on masks at 29.6 kPa (4.3 psi), 85% O2, 15% N2. Facility and organizational lessons-learned and process improvements were recorded during and following the tests, and subjective habitability ratings were recorded daily during the 11-day test. Hypoxia and DCS-related physiological and cognitive outcome measures were recorded during both tests and are reported in companion presentations. RESULTS & DISCUSSION: All subjects completed each of the tests. Primary habitability issues related to mask discomfort during simulated EVAs and poor sleep quality due to thin mattresses. Polybenzimidazole (PBI) clothing was worn by all subjects due to the increased fire risk and may be required for Artemis missions; clothing was found to be acceptable overall with the worst ratings being due to poor fit and inelasticity. Chamber O2 and CO2 sensor inconsistency was observed that did not result in test termination but required post-test follow-up. Forward plans include additional hypobaric testing and integration of existing and future physiological outcome data into an open-source Aerospace Estimation Tool for Hypobaric Exposure Risk (AETHER). NASA is also working to make the testing capability available to commercial companies.

Andrew F J Abercromby↗
NASA NTRSDate not supplied

Habitability Assessments And Lessons-learned From 3-day And 11-day Enriched Oxygen Hypobaric Chamber Tests At NASA Johnson Space Center

INTRODUCTION: Decompression sickness (DCS) is a risk to the health and performance of astronauts and high-altitude aircrew. Tolerance to flammability, hypoxia, prebreathe duration, and DCS risk varies across different organizations, vehicles, suits, and destinations, necessitating a variety of DCS risk mitigation approaches. Existing models of altitude DCS risk are often insufficient to enable accurate risk-informed decisions during hardware development, mission planning, and flight operations. METHODS: NASA completed outfitting of a dedicated facility at Johnson Space Center to support testing of up to eight human subjects for multiple days in hypobaric and enriched oxygen atmospheres. The primary purpose of the testing capability is validation of DCS risk mitigation protocols for Artemis missions to the Moon; however, it will also support development and validation of a generalizable altitude DCS risk estimation tool. A 3-day and an 11-day prebreathe validation test were completed in 2022, each with 8 human subjects living at 56.5 kPa (8.2 psia), 34% O2, 66% N2, with 5 simulated EVAs performed on masks at 29.6 kPa (4.3 psi), 85% O2, 15% N2. Facility and organizational lessons-learned and process improvements were recorded during and following the tests, and subjective habitability ratings were recorded daily during the 11-day test. Hypoxia and DCS-related physiological and cognitive outcome measures were recorded during both tests and are reported in companion presentations. RESULTS & DISCUSSION: All subjects completed each of the tests. Primary habitability issues related to mask discomfort during simulated EVAs and poor sleep quality due to thin mattresses. Polybenzimidazole (PBI) clothing was worn by all subjects due to the increased fire risk and may be required for Artemis missions; clothing was found to be acceptable overall with the worst ratings being due to poor fit and inelasticity. Chamber O2 and CO2 sensor inconsistency was observed that did not result in test termination but required post-test follow-up. Forward plans include additional hypobaric testing and integration of existing and future physiological outcome data into an open-source Aerospace Estimation Tool for Hypobaric Exposure Risk (AETHER). NASA is also working to make the testing capability available to commercial companies.

Andrew Abercromby↗
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 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 NTRS2020

Probability of Decompression Sickness and Venous Gas Emboli from 49 NASA Hypobaric Chamber Tests with Reference to Exploration Atmosphere

Introduction: Decompression sickness (DCS) is a complex biophysical event; it combines human perception of pain, for instance, and the presence of a gas phase in the tissues. Living tissues are complex and dynamic. Micronuclei and later bubbles may or may not form given what appears to be the same conditions. Even when bubbles grow, symptoms may or may not develop under what appears to be the same conditions. Therefore, at this time it is appropriate to consider DCS as a probabilistic rather than a deterministic event. Methods: Probabilistic models about hypobaric DCS and venous gas emboli (VGE) require a large amount of quality research data, a definition of decompression dose using physical and physiologic variables, and a flexible analytical approach that can quantify the association between each outcome and all covariates of interest (assuming independence between DCS and VGE) and then ultimately be extended to acknowledge dependencies between DCS and VGE. Our DCS and VGE data are from 1,031 hypobaric decompressions from 1983 to 2016. A total of 577 humans participated in 49 hypobaric chamber tests to evaluate denitrogenation procedures used by astronauts in the Space Shuttle and International Space Station programs. We defined decompression dose as the ratio of computed nitrogen tension in a theoretical 360-minute half-time compartment to ambient pressure, which accounts for denitrogenation and exposure pressure as well as explanatory variables such as age, sex, body mass index, and the presence or absence of ambulation as part of exercise at the exposure pressure. A parametric survival model, using a log-logistic distribution, was used to quantify the time to development of DCS, VGE, and Grade IV VGE. Results: Our survival estimates are applicable to simple hypobaric decompressions, such as depressurizations in 5 to 30 minutes to exposure pressures between 4 and 10 pounds per square inch absolute (psia) and after minutes to hours of denitrogenation, either under resting or exercise conditions to accelerated denitrogenation. The regressions are applicable to exposures between 2 to 6 hours and under conditions of ambulation or no ambulation as part of exercise at the test pressure. We estimate that an exposure to 4.3 psia with simulated extravehicular activity (EVA) that includes ambulation after equilibration to the exploration atmosphere at 8.2 psia with a 34% oxygen atmosphere will result in 3.1% DCS (1.8% to 5.2 95% confidence interval), 23.2% VGE (16.7 to 31.2%), and 8.5% Grade IV VGE (4.7 to 14.7%) in equal samples of men and women exposed for 6 hours. Discussion: Probabilistic models for DCS, VGE, and Grade IV VGE can be used to inform those that plan future EVAs. Their applications are useful to quantify the risk of DCS and VGE in astronauts that perform EVAs in low-pressure space suits while in space or while exploring the surfaces of the moon or Mars.

Johnny Conkin↗