Buoyant ascent rate profiles for the MK10 and MK11 submarine escape and immersion equipment.

Introduction: Since the U.S. Navy transitioned from the MK10 to the MK11 submarine escape and immersion equipment (SEIE), there has been an increase in the incident rate of pulmonary barotrauma during submarine escape training. This study compares the ascent rate profiles of the MK10 and MK11 SEIE to determine if ascent rate differences between the escape suits are associated with increased pulmonary barotraumas. Methods: Buoyant ascent rates of the MK10 and MK11 SEIE were compared using weighted manikins equivalent to the 1st, 50th, and 99th percentile body weight of a submariner. Human ascents using the MK11 (n=126) were compared to human ascents in the same trainer wearing the MK10 (n=124). Results: Manikin mean ascent times were faster for the MK10 than the MK11 (5.19 seconds vs 5.28 seconds, p ≺ 0.05). Terminal velocity (Vt) was affected by manikin weight (p ≺ 0.001). Human trials confirmed the manikin results. The average mean ascent velocity for the MK10 group was 0.155 meters/ second faster than the MK11 group's mean ascent velocity (p ≺ 0.001). Mean ascent velocity was inversely correlated with all anthropometrics for the MK10 group (p ≺ 0.01). Neither height nor body mass index showed a significant association with mean ascent velocity for the MK11 group. Conclusions: The Vt of buoyant ascents is significantly affected by body weight. As the mean ascent rate of the MK11 is slower than that of the MK10, ascent rate profile differences between the suits do not appear to explain the recent increase in pulmonary barotrauma incident rates during escape training.

Plasma Proteomics-Based Discovery of Mechanistic Biomarkers of Hyperbaric Stress and Pulmonary Oxygen Toxicity.

Our aim was to identify proteins that reflect an acute systemic response to prolonged hyperbaric stress and discover potential biomarker pathways for pulmonary O2 toxicity. The study was a double-blind, randomized, crossover design in trained male Navy diver subjects. Each subject completed two dry resting hyperbaric chamber dives separated by a minimum of one week. One dive exposed the subject to 6.5 h of 100% oxygen (O2) at 2ATA. The alternate dive exposed the subjects to an enhanced air nitrox mixture (EAN) containing 30.6% O2 at the same depth for the same duration. Venous blood samples collected before (PRE) and after (POST) each dive were prepared and submitted to LC-MS/MS analysis (2 h runs). A total of 346 total proteins were detected and analyzed. A total of 12 proteins were significantly increased at EANPOST (vs. EANPRE), including proteins in hemostasis and immune signaling and activation. Significantly increased proteins at O2PRE (vs. O2POST) included neural cell adhesion molecule 1, glycoprotein Ib, catalase, hemoglobin subunit beta, fibulin-like proteins, and complement proteins. EANPOST and O2POST differed in biomarkers related to coagulation, immune signaling and activation, and metabolism. Of particular interest is (EANPOST vs. O2POST), which is protective against oxidative stress.

Exhaled Nitric Oxide and Pulmonary Oxygen Toxicity Susceptibility.

Individual susceptibility to pulmonary oxygen toxicity (PO2tox) is highly variable and currently lacks a reliable biomarker for predicting pulmonary hyperoxic stress. As nitric oxide (NO) is involved in many respiratory system processes and functions, we aimed to determine if expired nitric oxide (FENO) levels can provide an indication of PO2tox susceptibility in humans. Eight U.S. Navy-trained divers volunteered as subjects. The hyperoxic exposures consisted of six- and eight-hour hyperbaric chamber dives conducted on consecutive days in which subjects breathed 100% oxygen at 202.65 kPa. Subjects' individual variability in pulmonary function and FENO was measured twice daily over five days and compared with their post-dive values to assess susceptibility to PO2tox. Only subjects who showed no decrements in pulmonary function following the six-hour exposure conducted the eight-hour dive. FENO decreased by 55% immediately following the six-hour oxygen exposure (n = 8, p < 0.0001) and by 63% following the eight-hour exposure (n = 4, p < 0.0001). Four subjects showed significant decreases in pulmonary function immediately following the six-hour exposure. These subjects had the lowest baseline FENO, had the lowest post-dive FENO, and had clinical symptoms of PO2tox. Individuals with low FENO were the first to develop PO2tox symptoms and deficits in pulmonary function from the hyperoxic exposures. These data suggest that endogenous levels of NO in the lungs may protect against the development of PO2tox.

Exhaled breath condensate profiles of U.S. Navy divers following prolonged hyperbaric oxygen (HBO) and nitrogen-oxygen (Nitrox) chamber exposures.

Prolonged exposure to hyperbaric hyperoxia can lead to pulmonary oxygen toxicity (PO2tox). PO2tox is a mission limiting factor for special operations forces divers using closed-circuit rebreathing apparatus and a potential side effect for patients undergoing hyperbaric oxygen (HBO) treatment. In this study, we aim to determine if there is a specific breath profile of compounds in exhaled breath condensate (EBC) that is indicative of the early stages of pulmonary hyperoxic stress/PO2tox. Using a double-blind, randomized 'sham' controlled, cross-over design 14 U.S. Navy trained diver volunteers breathed two different gas mixtures at an ambient pressure of 2 ATA (33 fsw, 10 msw) for 6.5 h. One test gas consisted of 100% O2(HBO) and the other was a gas mixture containing 30.6% O2with the balance N2(Nitrox). The high O2stress dive (HBO) and low O2stress dive (Nitrox) were separated by at least seven days and were conducted dry and at rest inside a hyperbaric chamber. EBC samples were taken immediately before and after each dive and subsequently underwent a targeted and untargeted metabolomics analysis using liquid chromatography coupled to mass spectrometry (LC-MS). Following the HBO dive, 10 out of 14 subjects reported symptoms of the early stages of PO2tox and one subject terminated the dive early due to severe symptoms of PO2tox. No symptoms of PO2tox were reported following the nitrox dive. A partial least-squares discriminant analysis of the normalized (relative to pre-dive) untargeted data gave good classification abilities between the HBO and nitrox EBC with an AUC of 0.99 (±2%) and sensitivity and specificity of 0.93 (±10%) and 0.94 (±10%), respectively. The resulting classifications identified specific biomarkers that included human metabolites and lipids and their derivatives from different metabolic pathways that may explain metabolomic changes resulting from prolonged HBO exposure.

Acute Exposure to Low-to-Moderate Carbon Dioxide Levels and Submariner Decision Making.

BACKGROUND: Submarines routinely operate with higher levels of ambient carbon dioxide (CO2) (i.e., 2000 - 5000 ppm) than what is typically considered normal (i.e., 400 - 600 ppm). Although significant cognitive impairments are rarely reported at these elevated CO2 levels, recent studies using the Strategic Management Simulation (SMS) test have found impairments in decision-making performance during acute CO2 exposure at levels as low as 1000 ppm. This is a potential concern for submarine operations, as personnel regularly make mission-critical decisions that affect the safety and efficiency of the vessel and its crew while exposed to similar levels of CO2. The objective of this study was to determine if submariner decision-making performance is impacted by acute exposure to levels of CO2 routinely present in the submarine atmosphere during sea patrols. METHODS: Using a subject-blinded balanced design, 36 submarine-qualified sailors were randomly assigned to receive 1 of 3 CO2 exposure conditions (600, 2500, or 15,000 ppm). After a 45-min atmospheric acclimation period, participants completed an 80-min computer-administered SMS test as a measure of decision making. RESULTS: There were no significant differences for any of the nine SMS measures of decision making between the CO2 exposure conditions. DISCUSSION: In contrast to recent research demonstrating cognitive deficits on the SMS test in students and professional-grade office workers, we were unable to replicate this effect in a submariner population-even with acute CO2 exposures more than an order of magnitude greater than those used in previous studies that demonstrated such effects.Rodeheffer CD, Chabal S, Clarke JM, Fothergill DM. Acute exposure to low-to-moderate carbon dioxide levels and submariner decision making. Aerosp Med Hum Perform. 2018; 89(6):520-525.

Effects of oral sodium nitrate on forearm blood flow, oxygenation and exercise performance during acute exposure to hypobaric hypoxia (4300 m).

A reduction in oxygen transport contributes to impaired exercise capacity at high altitude. Since blood flow is mediated, in part, by nitric oxide (NO), we hypothesized that sodium nitrate provided before forearm grip exercise performed at a simulated altitude of 4300 m (hypobaric hypoxia (HH)) would increase forearm blood flow and oxygenation, and decrease the decrement in grip performance. In a double-blind, randomized crossover study, 10 healthy subjects (9 males and 1 female) performed continuous (CGrip) and repeated rhythmic (RGrip) isometric forearm exercise until task failure in normobaric normoxia (NN), 2.5 h following consumption of placebo and sodium nitrate (15 mmol) in HH, and then again post-HH at sea-level pressure. Measurements included forearm blood flow (FBF) and anterior forearm tissue oxygenation (StO2), mean arterial blood pressure (MAP), arterial blood O2 saturation (SpO2), plasma NO reaction products (NOx) and nitrite, and exhaled NO (PENO). Compared to baseline testing in NN, performing CGrip and RGrip exercise in HH resulted in significant reductions in forearm blood flow, SaO2 and StO2, responses that were accompanied by significant performance decrements (∼10%) in both CGrip and RGrip exercise. In spite of a 10-fold increase in plasma NOx levels and a significant decrease in MAP during CGrip exercise following nitrate consumption, there were no significant main effects of treatment (placebo vs. sodium nitrate) for forearm blood flow, SpO2, StO2, or grip performance. PENO remained unchanged between NN, HH and post-HH conditions with placebo, but increased (∼24%) following nitrate supplementation in HH and post-HH. These data do not support a benefit in consuming a single dose of supplemental nitrate on forearm blood flow and isometric exercise in healthy adults at a simulated altitude of 4300 m.

Assessment of cognitive function while on low-dose propranolol: implications for usage by survivors in a disabled submarine.

While awaiting rescue from a disabled submarine (DISSUB), survivors will likely endure an atmosphere of rising CO2 which will eventually be lethal. Previously, it was determined that low-dose propranolol reduces resting metabolic carbon dioxide production and therefore may increase survival time in this scenario. The actions and decisions survivors would carry out in a DISSUB situation would require an unaltered cognition state. Therefore, we wanted to determine if low-dose propranolol impairs cognitive function. Eight healthy males completed a counterbalanced, randomized, placebo-controlled, double-blinded crossover study in which each subject received propranolol (40 mg twice daily) or placebo (lactose pill twice daily) over a 72-hour period. The alternate condition was separated by a minimum 96-hour washout period. Subjects performed a series of 6 tasks from the Automated Neuropsychological Assessment Metrics (ANAM) battery and answered a self-report sleepiness scale each morning and afternoon. Subjects exhibited increased accuracy in one of the ANAM tasks while on propranolol compared to placebo, but showed no difference between treatments on the other 5 tasks and sleepiness scale. These results suggest that 40 mg of propranolol taken twice daily does not significantly impair cognitive function and may be a viable option for use in a DISSUB scenario.

Propranolol's potential to increase survival time in a disabled submarine.

BACKGROUND: While awaiting rescue from a disabled submarine, survivors will likely endure an atmosphere of rising CO2 that will result in CO2 toxicity once the available emergency CO2 scrubbing materials are exhausted. Propranolol is a beta-blocker that may increase survival time by reducing metabolic CO2 production (VCO2). The purpose of this study was to determine if propranolol reduces resting VCO2 in healthy men. METHODS: Eight healthy men completed a counterbalanced, randomized, placebo-controlled, double-blinded crossover study in which each subject received propranolol (40 mg twice daily) or placebo (lactose pill twice daily) over 72 h. The alternate condition was separated by a minimum 96-h washout period. Resting VCO2, oxygen consumption (VO2), ventilation (VE), respiration rate (RR), respiratory exchange ratio (RER), mean arterial pressure (MAP), heart rate (HR), and cardiac output (Q) were measured each morning and afternoon. RESULTS: When compared to placebo, propranolol significantly reduced VCO2 (-6.5%), MAP (-3.6%), HR (-10.4%), and Q (-8.2%); however, there were no significant differences in VO2, RR, VE, or RER. DISCUSSION: These results show that 40 mg of propranolol taken twice daily reduces resting VCO2 in healthy men and suggests that this treatment strategy may increase survival time in a disabled submarine scenario.

Neoprene wet-suit hood affects low-frequency underwater hearing thresholds.

INTRODUCTION: Psychophysical measures of wet-suit hood sound attenuation are needed to provide the diving community with guidance on protection from underwater sound. METHODS: Underwater hearing thresholds were obtained from 15 male and 5 female recreational divers with and without a 3-mm thick wet-suit hood. Dives were conducted at a depth of 1 m in a large quiet anechoic pool. Thresholds were determined using a two-interval forced-choice procedure with a 0.71 probability of positive response at convergence. A 1-s pure tone was presented with a 20-ms rise and fall time at 100, 200, 250, 300, 400, and 500 Hz. RESULTS: Without a wet-suit hood, mean thresholds decreased from 99 dB re 1 microPa at 100 Hz to 85 dB at 500 Hz. Thresholds were statistically similar at 100 to 300 Hz with and without the wet-suit hood, but were significantly increased at 400 and 500 Hz with the hood (p < 0.001). CONCLUSIONS: In conclusion, at shallow depths, a 3-mm neoprene wet-suit hood attenuates underwater sound by approximately 10 dB for frequencies between 400 Hz and 500 Hz. At frequencies below 400 Hz, a 3-mm neoprene wet-suit hood offers no sound protection.