Aviation, space, and environmental medicine最新文献

Introduction: Continuous positive airway pressure (CPAP) is used in air ambulances to treat patients with impaired oxygenation. Differences in mechanical principles between CPAP devices may affect their performance at different ambient air pressures, as will occur in an air ambulance during flight.

Methods: Two different CPAP systems, a threshold resistor device and a flow resistor device, at settings of 5 and 10 cm H₂O were examined. Static pressure, static airflow, and pressure during simulated breathing were measured at ground level and at three different altitudes [2400 m (7874 ft), 3000 m (9843 ft), and 10,700 m (35,105 ft)].

Results: When altitude increased, the performance of the two CPAP systems differed during both static and simulated breathing pressure measurements. With the threshold resistor CPAP, measured pressure levels were close to the preset CPAP level. Static pressure decreased 0.71 ± 0.35 cm H₂O at CPAP 10 cm H₂O compared to ground level and 35,105 ft (10,700 m). With the flow resistor CPAP, as the altitude increased, CPAP produced pressure levels increased. At 35,105 ft (10,700 m), the increase was 5.13 ± 0.33 cm H₂O at CPAP 10 cm H₂O.

Discussion: The velocity of airflow through the flow resistor CPAP device is strongly influenced by reduced ambient air pressure, leading to a higher delivered CPAP effect than the preset CPAP level. Threshold resistor CPAP devices seem to have robust performance regardless of altitude. Thus, the threshold resistor CPAP device is probably more appropriate for CPAP treatment in an air ambulance cabin, where ambient pressure will vary during patient transport.

Background: Decompression sickness is caused by bubbles of inert gas predominantly found in the venous circulation. Bubbles may exist longer when covered by a surfactant layer reducing surface tension. Surfactant candidates, based on 3D-structure and availability, are long-chain fatty acids (FFAs). It is hypothesized that sufficient molecular dissolved FFA (dFFA) result in higher bubble grades (BGs).

Methods: Participating divers (52) either had a fat-rich or a fat-poor breakfast. After a dry dive simulation (21 msw/40 min), BGs were determined at 40, 80, 120, and 160 min after surfacing by the precordial Doppler method. The four individual scores were transformed to the Kisman Integrated Severity Score (KISS).

Results: Kiss was not affected by meal fat content, and KISS and dFFA (calculated) were not associated, even though the fat-rich group had 3.5 times more dFFA. A paired approach (11 subjects exposed to fat-rich and fat-poor meals) yielded the same results. The measured FFA (albumin bound) was present in abundance, yet the long-chain dFFA concentration was probably too low (nM range) to form a surfactant monolayer, as follows from micelle theory.

Conclusion: Bubble scores are not associated with dFFAs. Theoretically it is questionable whether long-chain dFFAs could form post-dive monolayers. It remains unclear which substance forms the surfactant layer around bubbles.

Introduction: Some commercial spaceflight participants (SFPs) may have medical conditions that require implanted medical devices (IMDs), such as cardiac pacemakers, defibrillators, insulin pumps, or similar electronic devices. The effect of space radiation on the function of IMDs is unknown. This review will identify known effects of terrestrial and aviation electromagnetic interference (EMI) and radiation on IMDs in order to provide insight into the potential effects of radiation exposures in the space environment.

Methods: A systematic literature review was conducted on available literature on human studies involving the effects of EMI as well as diagnostic and therapeutic radiation on IMDs.

Results: The literature review identified potential transient effects from EMI and diagnostic radiation levels as low as 10 mGy on IMDs. High-energy, therapeutic, ionizing radiation can cause more permanent device malfunctions at doses as low as 40 mGy. Radiation doses from suborbital flight altitudes and durations are anticipated to be less than those experienced during an average round-trip, cross-country airline flight and are unlikely to result in significant detriment, though longer, orbital flights may expose SFPs to doses potentially harmful to IMD function.

Discussion: Individuals with IMDs should experience few, if any, radiation-related device malfunctions during suborbital flight, but could have problems with radiation exposures associated with longer, orbital flights.

Introduction: An important problem for pilots is visual disturbances occurring under +Gz acceleration. Assessment of the degree of intensification of these disturbances is generally accepted as the acceleration tolerance level (ATL) criterion determined in human centrifuges. The aim of this research was to evaluate the visual-motor responses of pilots during rapidly increasing acceleration contained in cyclic intervals of +6 Gz to the maximum ATL.

Methods: The study involved 40 male pilots ages 32-41 yr. The task was a quick and faultless response to the light stimuli presented on a light bar during exposure to acceleration until reaching the ATL. Simple response time (SRT) measurements were performed using a visual-motor analysis system throughout the exposures which allowed assessment of a pilot's ATL.

Results: There were 29 pilots who tolerated the initial phase of interval acceleration and achieved +6 Gz, completing the test at ATL. Relative to the control measurements, the obtained results indicate a significant effect of the applied acceleration on response time. SRT during +6 Gz exposure was not significantly longer compared with the reaction time between each of the intervals. SRT and erroneous reactions indicated no statistically significant differences between the "lower" and "higher" ATL groups.

Conclusion: SRT measurements over the +6-Gz exposure intervals did not vary between "lower" and "higher" ATL groups and, therefore, are not useful in predicting pilot performance. The gradual exposure to the maximum value of +6 Gz with exposure to the first three intervals on the +6-Gz plateau effectively differentiated pilots.