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All sourcesNASA NTRSDOE OSTI
NASA NTRS2007

A Start Toward Micronucleus-Based Decompression Models; Altitude Decompression

Do gaseous micronuclei trigger the formation of bubbles in decompression sickness (DCS)? Most previous instructions for DCS prevention have been oriented toward supersaturated gas in tissue. We are developing a mathematical model that is oriented toward the expected behavior of micronuclei. The issue is simplified in altitude decompressions because the aviator or astronaut is exposed only to decompression, whereas in diving there is a compression before the decompression. The model deals with four variables: duration of breathing of 100% oxygen before going to altitude (O2 prebreathing), altitude of the exposure, exposure duration, and rate of ascent. Assumptions: a) there is a population of micronuclei of various sizes having a range of characteristics, b) micronuclei are stable until they grow to a certain critical nucleation radius, c) it takes time for gas to diffuse in or out of micronuclei, and d) all other variables being equal, growth of micronuclei upon decompression is more rapid at high altitude because of the rarified gas in the micronuclei. To estimate parameters, we use a dataset of 4,756 men in altitude chambers exposed to various combinations of the model s variables. The model predicts occurrence of DCS symptoms quite well. It is notable that both the altitude chamber data and the model show little effect of O2 prebreathing until it lasts more than 60 minutes; this is in contrast to a conventional idea that the benefit of prebreathing is directly due to exponential washout of tissue nitrogen. The delay in response to O2 prebreathing can be interpreted as time required for outward diffusion of nitrogen; when the micronuclei become small enough, they are disabled, either by crushing or because they cannot expand to a critical nucleation size when the subject ascends to altitude.

Van Liew, H. D.↗
NASA NTRS1993

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.↗
NASA NTRS2007

Potential Fifty Percent Reduction in Saturation Diving Decompression Time Using a Combination of Intermittent Recompression and Exercise

Conventional saturation decompression protocols use linear decompression rates that become progressively slower at shallower depths, consistent with free gas phase control vs. dissolved gas elimination kinetics. If decompression is limited by control of free gas phase, linear decompression is an inefficient strategy. The NASA prebreathe reduction program demonstrated that exercise during O2 prebreathe resulted in a 50% reduction (2 h vs. 4 h) in the saturation decompression time from 14.7 to 4.3 psi and a significant reduction in decompression sickness (DCS: 0 vs. 23.7%). Combining exercise with intermittent recompression, which controls gas phase growth and eliminates supersaturation before exercising, may enable more efficient saturation decompression schedules. A tissue bubble dynamics model (TBDM) was used in conjunction with a NASA exercise prebreathe model (NEPM) that relates tissue inert gas exchange rate constants to exercise (ml O2/kg-min), to develop a schedule for decompression from helium saturation at 400 fsw. The models provide significant prediction (p < 0.001) and goodness of fit with 430 cases of DCS in 6437 laboratory dives for TBDM (p = 0.77) and with 22 cases of DCS in 159 altitude exposures for NEPM (p = 0.70). The models have also been used operationally in over 25,000 dives (TBDM) and 40 spacewalks (NEPM). The standard U.S. Navy (USN) linear saturation decompression schedule from saturation at 400 fsw required 114.5 h with a maximum Bubble Growth Index (BGI(sub max)) of 17.5. Decompression using intermittent recompression combined with two 10 min exercise periods (75% VO2 (sub peak)) per day required 54.25 h (BGI(sub max): 14.7). Combined intermittent recompression and exercise resulted in a theoretical 53% (2.5 day) reduction in decompression time and theoretically lower DCS risk compared to the standard USN decompression schedule. These results warrant future decompression trials to evaluate the efficacy of this approach.

Gernhardt, Michael I.↗
NASA NTRS1996

Cardiopulmonary Changes with Moderate Decompression in Rats

Sprague-Dawley rats were compressed to 616 kPa for 120 min then decompressed at 38 kPa/min to assess the cardiovascular and pulmonary responses to moderate decompression stress. In one series of experiments the rats were chronically instrumented with Doppler ultrasonic probes for simultaneous measurement of blood pressure, cardiac output, heart rate, left and right ventricular wall thickening fraction, and venous bubble detection. Data were collected at base-line, throughout the compression/decompression protocol, and for 120 min post decompression. In a second series of experiments the pulmonary responses to the decompression protocol were evaluated in non-instrumented rats. Analyses included blood gases, pleural and bronchoalveolar lavage (BAL) protein and hemoglobin concentration, pulmonary edema, BAL and lung tissue phospholipids, lung compliance, and cell counts. Venous bubbles were directly observed in 90% of the rats where immediate post-decompression autopsy was performed and in 37% using implanted Doppler monitors. Cardiac output, stroke volume, and right ventricular wall thickening fractions were significantly decreased post decompression, whereas systemic vascular resistance was increased suggesting a decrease in venous return. BAL Hb and total protein levels were increased 0 and 60 min post decompression, pleural and plasma levels were unchanged. BAL white blood cells and neutrophil percentages were increased 0 and 60 min post decompression and pulmonary edema was detected. Venous bubbles produced with moderate decompression profiles give detectable cardiovascular and pulmonary responses in the rat.

Robinson, R.↗
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 NTRS1995

Cardiovascular Pressures with Venous Gas Embolism and Decompression

Venous gas embolism (VGE) is reported with decompression to a decreased ambient pressure. With severe decompression, or in cases where an intracardiac septal defect (patent foramen ovale) exists, the venous bubbles can become arterialized and cause neurological decompression illness. Incidence rates of patent foramen ovale in the general population range from 25-34% and yet aviators, astronauts, and deepsea divers who have decompression-induced venous bubbles do not demonstrate neurological symptoms at these high rates. This apparent disparity may be attributable to the normal pressure gradient across the atria of the heart that must be reversed for there to be flow potency. We evaluated the effects of: venous gas embolism (0.025, 0.05 and 0.15 ml/ kg min for 180 min.) hyperbaric decompression; and hypobaric decompression on the pressure gradient across the left and right atria in anesthetized dogs with intact atrial septa. Left ventricular end-diastolic pressure was used as a measure of left atrial pressure. In a total of 92 experimental evaluations in 22 dogs, there were no reported reversals in the mean pressure gradient across the atria; a total of 3 transient reversals occurred during the peak pressure gradient changes. The reasons that decompression-induced venous bubbles do not consistently cause serious symptoms of decompression illness may be that the amount of venous gas does not always cause sufficient pressure reversal across a patent foramen ovale to cause arterialization of the venous bubbles.

Butler, B. D.↗
NASA NTRS2014

Ambulation Increases Decompression Sickness in Spacewalk Simulations

Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS. METHODS Four experiments will replicate the CEVIS exercise-enhanced oxygen prebreathe protocol, each with a different exception. The first of these is currently underway. Experiment 1 - Subjects complete controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining nonambulatory throughout. Experiment 2 - Subjects remain non-ambulatory during the preflight period and ambulatory at 4.3 psi. Experiment 3 - Subjects ambulate during the preflight period and remain non-ambulatory at 4.3 psi. Experiment 4 - The order of heavy and light exercise employed in the CEVIS protocol is reversed, with the light exercise occurring first (subjects remain non-ambulatory throughout). Decompression stress is assessed with non-invasive ultrasound during each of 14 epochs of a 4 hour simulated spacewalk at 4.3 psi; aural Doppler is used to monitor bubbles (Spencer grade 0-IV scale) passing through the pulmonary artery, and two-dimensional echocardiographic imaging is used to look for left ventricular gas emboli (LVGE; the presence of which is a test termination criterion). Venous blood is collected at baseline and twice following repressurization to determine if the decompression stress is correlated with microparticles (cell fragments) accumulation. The plan is to test 25-50 subjects in each experiment. Fisher Exact Tests (one-tailed) are used to compare test and control groups. Trials are suspended when the DCS or grade IV VGE observations reach 70% confidence of DCS risk >15% and grade IV VGE risk >20%. RESULTS Experiment 1 was concluded with 20 complete trials (15 male, 5 female) since the statistical outcome would not change with five additional trials. The observed DCS was significantly greater in Experiment 1 than in CEVIS trials (4/20 [20%] vs. 0/45 [0%], respectively, p=0.007), as was the frequency of peak grade IV VGE (6/21 [29%; including one additional subject that presented grade IV VGE but whose trial was ended before completion when LVGE were observed] vs. 3/45 [7%], respectively, p=0.024). Experiment 3 trials are now underway, with 11 trials completed (10 male, 1 female). Preliminary results indicate no difference in observed DCS between Experiment 3 and CEVIS trials (1/11 [9%] vs. 0/45 [0%], respectively, p=0.196), or between Experiment 3 and Experiment 1 trials (p=0.405). The frequency of peak grade IV VGE in Experiment 3 (2/11 [18%]) did not differ from CEVIS or Experiment 1 trials (p=0.251 and p=0.425, respectively). Microparticle patterns are widely variable and still under analysis. DISCUSSION The results of the Experiment 1 trials support the thesis that decompression stress is increased by ambulation exercise, given the higher incidence of DCS and grade IV VGE when compared to the non-ambulatory PRP CEVIS trials. Experiment 3 trials are incomplete, but suggest that the effect of ambulation during ground level preflight oxygen breathing alone, when subjects are undersaturated with inert gas, may not differ in risk from ambulation at both preflight and spacesuit pressures, the latter when subjects are supersaturated with inert gas. Further trials are needed to confirm the relative effects of ambulation in undersaturated vs. supersaturated states and to determine whether light exercise facilitates the removal of heavy exercise-induced nucleation (Experiment 4).

Pollock, N. W.↗
NASA NTRS1997

Dibutyryl cAMP effects on thromboxane and leukotriene production in decompression-induced lung injury

Decompression-induced venous bubble formation has been linked to increased neutrophil counts, endothelial cell injury, release of vasoactive eicosanoids, and increased vascular membrane permeability. These actions may account for inflammatory responses and edema formation. Increasing the intracellular cAMP has been shown to decrease eicosanoid production and edema formation in various models of lung injury. Reduction of decompression-induced inflammatory responses was evaluated in decompressed rats pretreated with saline (controls) or dibutyryl cAMP (DBcAMP, an analog of cAMP). After pretreatment, rats were exposed to either 616 kPa for 120 min or 683 kPa for 60 min. The observed increases in extravascular lung water ratios (pulmonary edema), bronchoalveolar lavage, and pleural protein in the saline control group (683 kPa) were not evident with DBcAMP treatment. DBcAMP pretreatment effects were also seen with the white blood cell counts and the percent of neutrophils in the bronchoalveolar lavage. Urinary levels of thromboxane B2, 11-dehydrothromboxane B2, and leukotriene E4 were significantly increased with the 683 kPa saline control decompression exposure. DBcAMP reduced the decompression-induced leukotriene E4 production in the urine. Plasma levels of thromboxane B2, 11-dehydrothromboxane B2, and leukotriene E4 were increased with the 683-kPa exposure groups. DBcAMP treatment did not affect these changes. The 11-dehydrothromboxane B2 and leukotriene E4 levels in the bronchoalveolar lavage were increased with the 683 kPa exposure and were reduced with the DBcAMP treatment. Our results indicate that DBcAMP has the capability to reduce eicosanoid production and limit membrane permeability and subsequent edema formation in rats experiencing decompression sickness.

Non-NASA Center↗
NASA NTRS1987

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↗
NASA NTRS1993

Risk of decompression sickness in the presence of circulating microbubbles

In this study, we examined the association between microbubbles formed in the circulation from a free gas phase and symptoms of altitude decompression sickness (DCS). In a subgroup of 59 males of mean (S.D) age 31.2 (5.8) years who developed microbubbles during exposure to 26.59 kPa (4.3 psi) under simulated extravehicular activities (EVA), symptoms of DCS occurred in 24 (41 percent) individuals. Spencer grade 1 microbubbles occurred in 4 (7 percent), grade 2 in 9 (15 percent), grade 3 in 15 (25 percent), and grade 4 in 31 (53 percent) of subjects. Survival analysis using Cox proportional hazards regression showed that individuals with less than grade 3 CMB showed 2.46 times (95 percent confidence interval = 1.26 to 5.34) higher risk of symptoms. This information is crucial for defining the risk of DCS for inflight Doppler monitoring under space EVA. Altitude decompression sickness (DCS) occurs when there is acute reduction in ambient pressure. The symptoms of DCS are due to the formation of a free gas phase (in the form of gas microbubbles) in tissues during decompression. Musculo-skeletal pain of bends is the commonest form of DCS in altitude exposures. In the space flight environment, there is a risk of DCS when astronauts decompress from the normobaric shuttle pressure into the hypobaric space suit pressure (currently about 29.65 kPa (4.3 psi) for extra-vehicular activities (EVA). This risk is counterbalanced by a judicious combination of prior denitrogenation and staged decompression. Studies of DCS are limited by the duration of the test at reduced pressure. Since only a proportion of subjects tested develop symptoms, the information on DCS is generally incomplete or 'censored'. Many studies employ Doppler ultrasound monitoring of the precordial area for detecting circulating microbubbles (CMB). Although the association between CMB and bends pain is not causal, CMB are frequently monitored during decompression. In this paper, we examine the association between CMB and symptoms of DCS under simulated EVA profiles.

Kumar, K. Vasantha↗
NASA NTRS2014

Ambulation Increases Decompression Sickness in Altitude Exposure

INTRODUCTION - Exercise accelerates inert gas elimination during oxygen breathing prior to decompression (prebreathe), but may also promote bubble formation and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of exercise are likely critical to the net effect. The NASA Prebreathe Reduction Program (PRP) combined oxygen prebreathe and exercise preceding a 4.3 psi exposure in non-ambulatory subjects (a microgravity analog) to produce two protocols now used by astronauts preparing for extravehicular activity (CEVIS and ISLE). Additional work is required to investigate whether exercise normal to 1 G environments increases the risk of DCS over microgravity simulation. METHODS - The CEVIS protocol was replicated with one exception. Our subjects completed controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining non-ambulatory throughout. Decompression stress was graded with aural Doppler (Spencer 0-IV scale). Two-dimensional echocardiographic imaging was used to look for left heart gas emboli (the presence of which prompted test termination). Venous blood was collected at three points to correlate Doppler measures of decompression stress with microparticle (cell fragment) accumulation. Fisher Exact Tests compared test and control groups. Trial suspension would occur when DCS risk >15% or grade IV venous gas emboli (VGE) risk >20% (at 70% confidence). RESULTS - Eleven person-trials were completed (9 male, 2 female) when DCS prompted suspension. DCS was greater than in CEVIS trials (3/11 [27%] vs. 0/45 [0%], respectively, p=0.03). Statistical significance was not reached for peak grade IV VGE (2/11 [18%] vs. 3/45 [7%], p=0.149) or cumulative grade IV VGE observations per subject-trial (8/128 [6%] vs. 26/630 [4%], p=0.151). Microparticle data were collected for 5/11 trials (3 with DCS outcomes), with widely varying patterns that could not be resolved statistically. CONCLUSION - We did find that that ambulation increases decompression stress. Additional trials would improve the statistical power to assess differences in VGE and to evaluate the relationship between decompression stress and microparticles.

Conkin, Johnny↗
NASA NTRS1987

The effect of extended O2 prebreathing on altitude decompression sickness and venous gas bubbles

The purpose of this study was to determine the effect of extended O2 prebreathing on symptom and bubble incidence during decompressions simulating extravehicular activity. The 38 subjects breathed O2 for a 6-hr period prior to decompression to 4.3 psi. The subjects performed upper body exercises for 6 hr. Eight subjects were exposed to the same protocol after an 8-hr prebreathe. Venous bubbles were detected in 18 of 38 subjects decompressed after the 6-hr prebreathe. Four of these subjects reported symptoms of altitude decompression sickness. No symptoms or bubbles were detected in the eight subjects who had prebreathed 8 hr. The incidence of symptoms and bubbles, when combined with prior data on 3.5- and 4.0-hr prebreathes, showed an inverse correlation to prebreathing time. The incidence of symptoms was higher than has been reported for subjects exposed to decompression of shorter duration with less activity.

Waligora, James M.↗
NASA NTRS1994

Exercise with prebreathe appears to increase protection from decompression sickness: Preliminary findings

Extravehicular activity (EVA) from the Space Shuttle involves one hour of prebreath with 100% oxygen, decompression of the entire Shuttle to 10.2 psia for at least 12 hours, and another prebreath for 40 minutes before decompression to the 4.3 psia suit pressure. We are investigating the use of a one-hour prebreathe with 100% oxygen beginning with a ten-minute strenuous exercise period as an alternative for the staged decompression schedule described above. The 10-minute exercise consists of dual-cycle ergometry performed at 75% of the subject's peak oxygen uptake to increase denitrogenation efficiency by increasing ventilation and perfusion. The control exposures were preceded by a one-hour prebreathe with 100% oxygen while resting in a supine position. The twenty-two male subjects were exposed to 4.3 psia for 4 hours while performing light to moderate exercise. Preliminary results from 22 of the planned 26 subjects indicate 76% DCS following supine, resting prebreathe and 38% following prebreathe with exercise. The staged decompression schedule has been shown to result in 23% DCS which is not significantly different from the exercise-enhanced prebreathe results. Prebreathe including exercise appears to be comparable to the protection afforded by the more lengthy staged decompression schedule. Completion of the study later this year will enable planned statistical analysis of the results.

Webb, James T.↗
NASA NTRS1999

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.↗
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↗
NASA NTRS2001

A Log Logistic Survival Model Applied to Hypobaric Decompression Sickness

Decompression sickness (DCS) is a complex, multivariable problem. A mathematical description or model of the likelihood of DCS requires a large amount of quality research data, ideas on how to define a decompression dose using physical and physiological variables, and an appropriate analytical approach. It also requires a high-performance computer with specialized software. I have used published DCS data to develop my decompression doses, which are variants of equilibrium expressions for evolved gas plus other explanatory variables. My analytical approach is survival analysis, where the time of DCS occurrence is modeled. My conclusions can be applied to simple hypobaric decompressions - ascents lasting from 5 to 30 minutes - and, after minutes to hours, to denitrogenation (prebreathing). They are also applicable to long or short exposures, and can be used whether the sufferer of DCS is at rest or exercising at altitude. Ultimately I would like my models to be applied to astronauts to reduce the risk of DCS during spacewalks, as well as to future spaceflight crews on the Moon and Mars.

Conkin, Johnny↗
NASA NTRS2003

Age affects severity of venous gas emboli on decompression from 14.7 to 4.3 psia

INTRODUCTION: Variables that define who we are, such as age, weight and fitness level influence the risk of decompression sickness (DCS) and venous gas emboli (VGE) from diving and aviation decompressions. We focus on age since astronauts that perform space walks are approximately 10 yr older than our test subjects. Our null hypothesis is that age is not statistically associated with the VGE outcomes from decompression to 4.3 psia. METHODS: Our data are from 7 different NASA tests where 188 men and 50 women performed light exercise at 4.3 psia for planned exposures no less than 4 h. Prebreathe (PB) time on 100% oxygen ranged from 150-270 min, including ascent time, with exercise of different intensity and length being performed during the PB in four of the seven tests with 150 min of PB. Subjects were monitored for VGE in the pulmonary artery using a Doppler ultrasound bubble detector for a 4-min period every 12 min. There were six design variables; the presence or absence of lower body adynamia and five PB variables; plus five concomitant variables on physical characteristics: age, weight height, body mass index, and gender that were available for logistic regression (LR). We used LR models for the probability of DCS and VGE, and multinomial logit (ML) models for the probability of Spencer VGE Grades 0-IV at exposure times of 61, 95, 131, 183 min, and for the entire exposure. RESULTS: Age was significantly associated with VGE in both the LR and ML models, so we reject the null hypothesis. Lower body adynamia was significant for all responses. CONCLUSIONS: Our selection of tests produced a wide range of the explanatory variables, but only age, lower body adynamia, height, and total PB time was helpful in various combinations to model the probability of DCS and VGE.

Clinical Trial↗