Gas embolism and surfactant-based intervention: implications for long-duration space-based activity.

Intravascular gas embolism can occur with decompression in space flight, and it commonly occurs during cardiac and vascular surgery. Intravascular bubbles may be deposited into any end organ such as the heart or the brain. Surface interactions between the bubble and the endothelial cells lining the vasculature result in serious impairment of blood flow and can lead to heart attack, stroke, or even death. Surfactant-based intervention is a novel treatment for gas embolism. Intravascular surfactant can adsorb onto the gas-liquid interface and compete with blood-borne macromolecules for interfacial occupancy. Surfactants can retard the progress of pathophysiological molecular and cellular events stimulated by the bubble surface, including endothelial cell injury and initiation of blood clotting. Bulk and surface transport of a surfactant to provide competition for interfacial occupancy is a therapeutic strategy because surfactant adsorption can dominate protein (or other macromolecule) adsorption. The presence of surfactant along the gas-liquid interface also induces variation in the interfacial tension, which in turn affects the blood flow and the bubble motion. We describe the interplay between biological transport processes and physiological events occurring and the cellular and molecular level in vascular gas embolization. Special consideration is given to modeling the transport and hydrodynamic interactions associated with surfactant-based intervention.

Patent foramen ovale and paradoxical systemic embolism: a bibliographic review.

A patent foramen ovale (PFO) has been reported to be an important risk factor for cardioembolic cerebrovascular accidents through paradoxical systemic embolization, and it provides one potential mechanism for the paradoxical systemic embolization of venous gas bubbles produced after altitude or hyperbaric decompressions. Here, we present in a single document a summary of the original findings and views from authors in this field. It is a comprehensive review of 145 peer-reviewed journal articles related to PFO that is intended to encourage reflection on PFO detection methods and on the possible association between PFO and stroke. There is a heightened debate on whether aviators, astronauts, and scuba divers should go through screening for PFO. Because it is a source of an important controversy, we prefer to present the findings in the format of a neutral bibliographic review independent of our own opinions. Each cited peer-reviewed article includes a short summary in which we attempt to present potential parallels with the pathophysiology of decompression bubbles. Two types of articles are summarized, as follows. First, we report the original clinical and physiological findings which focus on PFO. The consistent reporting sequence begins by describing the method of detection of PFO and goal of the study, followed by bulleted results, and finally the discussion and conclusion. Second, we summarize from review papers the issues related only to PFO. At the end of each section, an abstract with concluding remarks based on the cited articles provides guidelines.

European EVA decompression sickness risks.

For the first manned flight of Hermes there will be a capability of performing EVA. The European EVA Space Suit will be an anthropomorphic system with an internal pressure of 500 hPa of pure oxygen. The pressure reduction from the Hermes cabin pressure of 1013 hPa will induce a risk for Decompression Sickness (DCS) for the EVA crewmember if no adequate protective procedures are implemented. Specific decompression procedures have to be developed. From a critical review of the literature and by using knowledge gained from research conducted in the past in the fields of diving and aerospace medicine safe protective procedures are proposed for the European EVA scenario. An R factor of 1.2 and a tissue half-time (t1/2) of 360 minutes in a single-tissue model have been identified as appropriate operational values. On the basis of an acceptable risk level of approximately 1%, oxygen prebreathing times are proposed for (a) direct pressure reduction from 1013 hPa to a suit pressure of 500 hPa, and (b) staged decompression using a 700 hPa intermediate stage in the spacecraft cabin. In addition, factors which influence individual susceptibility to DCS are identified. Recommendations are also given in the areas of crew selection and medical monitoring requirements together with therapeutic measures that can be implemented in the Hermes scenario. A method for demonstration of the validity of proposed risks and procedures is proposed.