Joseph Fischer

Air Break During Preoxygenation and Risk of Altitude Decompression Sickness

INTRODUCTION To reduce the risk of decompression sickness (DCS), current USAF U-2 operations require a 1-h preoxygenation (PreOx). An interruption of oxygen breathing with air breathing currently requires significant extension of the PreOx time. The purpose of this study was to evaluate the relationship between air breaks during PreOx and subsequent DCS and venous gas emboli (VGE) incidence, and to determine safe air break limits for operational activities. METHODS Volunteers performed 30 min of PreOx, followed by either a 10-min, 20-min, or 60-min air break, then completed another 30 min of PreOx, and began a 4-h altitude chamber exposure to 9144 m (30,000 ft). Subjects were monitored for VGE using echocardiography. Altitude exposure was terminated if DCS symptoms developed. Control data (uninterrupted 60-min PreOx) to compare against air break data were taken from the AFRL DCS database. RESULTS At 1 h of altitude exposure, DCS rates were significantly higher in all three break in prebreathe (BiP) profiles compared to control (40%, 45%, and 47% vs. 24%). At 2 h, the 20-min and 60-min BiP DCS rates remained higher than control (70% and 69% vs. 52%), but no differences were found at 4 h. No differences in VGE rates were found between the BiP profiles and control. DISCUSSION Increased DCS risk in the BiP profiles is likely due to tissue renitrogenation during air breaks not totally compensated for by the remaining PreOx following the air breaks. Air breaks of 10 min or more occurring in the middle of 1 h of PreOx may significantly increase DCS risk during the first 2 h of exposure to 9144 m when compared to uninterrupted PreOx exposures.

Acceleration tolerance after ingestion of a commercial energy drink.

BACKGROUND Caffeine ingestion has been demonstrated to increase physical performance in some situations. This study examined the ability of a commercial energy drink containing caffeine to enhance acceleration tolerance and strength under G load. METHODS Eight experienced centrifuge subjects completed three separate experimental acceleration exposures following ingestion of 11.5 ml x kg(-1) bodyweight of (1) a commercial energy drink, providing 5.0 mg caffeine/kg bodyweight; (2) a commercial energy drink without caffeine; or 3) a placebo. The acceleration exposures consisted of a relaxed gradual onset run to peripheral light loss, a rapid onset run to 6 G for 15 s, and a simulated air combat maneuver (SACM) run of repeated alternations between 4.5 G for 15 s and 7 G for 15 s until volitional exhaustion. RESULTS Relaxed G tolerance was 13% higher under the caffeinated energy drink session, whereas SACM duration did not differ among the drink conditions. Hip adductor muscle strength was 37% lower during the placebo session than during the other two sessions. CONCLUSION Consumption of a caffeine-based energy drink may enhance relaxed G tolerance and may increase strength, but does not impact acceleration tolerance duration.

Acceleration tolerance at night with acute fatigue and stimulants.

INTRODUCTION The impact of pharmacological agents on aviators concerns all flight surgeons. This study tested the related hypotheses that acute fatigue reduces +Gz tolerance and endurance, and that stimulants can partially reverse this impact. Additionally, the researchers attempted to develop a test battery sensitive enough to detect subtle differences in aviator cognition and performance among conditions. METHODS To determine the effect of fatigue on +Gz tolerance and the impact of stimulant use, 10 male centrifuge subjects, mean age 32, from Brooks City-Base, TX, were tested in a repeated measures study under five nighttime conditions following an average of 22 h of sustained wakefulness during their circadian nadir. Using a within-subject design, subjects received placebo, dextroamphetamine 10 mg, modafinil 200 mg, methylphenidate 10 mg, and pemoline 37.5 mg at night, and were tested during a daytime control session. Cognitive/performance tests were administered before each centrifuge run. RESULTS No difference in +Gz tolerance or endurance was detected among conditions. The cognitive/performance tests also did not detect any differences. Subject perception that anti-G straining maneuver (AGSM) difficulty was greater during the night placebo condition than during the daytime control, methylphenidate and modafinil night conditions reached statistical significance (P = 0.005, 0.012, 0.022, respectively). DISCUSSION Physiological changes during the circadian nadir following acute sleep deprivation do not appear to negatively impact +Gz tolerance. A standardized protocol sufficiently sensitive to detect subtle behavioral and performance effects would be useful to test and compare the effect of other pharmacological agents on aviators.

Cognition Effects of Low-Grade Hypoxia

INTRODUCTION The effects of low-grade hypoxia on cognitive function are reported in this paper. The study compared cognitive function during short exposures at four different altitudes. METHODS Ninety-one subjects were exposed to simulated altitudes of ground level, 1524, 2438, and 3658 m (5000, 8000, and 12,000 ft) in the Brooks City-Base altitude pressure chamber in a balanced design. Oxygen saturation, heart rate, and cognitive performance on seven different cognitive tasks were measured. In addition, subjects indicated their symptoms from a 33-item subjective symptom survey. RESULTS As designed, oxygen saturation decreased and heart rate increased with higher altitudes. Very small degradations in performance were found at the two highest altitudes for only two of the cognitive tasks (continuous performance and grammatical reasoning). In the subjective symptom survey, 18 of the 33 possible symptoms were more common at 3658 m (12,000 ft) than at ground level. CONCLUSIONS The findings indicated a minimal influence of low-grade hypoxia on cognitive performance in contrast to some existing classic symptoms of hypoxia. Pilmanis AA, Balldin UI, Fischer JR. Cognition effects of low-grade hypoxia. Aerosp Med Hum Perform. 2016; 87(7):596-603.

Hyperoxia and Hypoxic Hypoxia Effects on Simple and Choice Reaction Times

INTRODUCTION Effects of exposure to hyperoxia (PiO2 > 105 mmHg), normoxia (PiO2 95-105 mmHg) and hypoxia (PiO2 < 95 mmHg) on simple and choice reaction performance tasks were evaluated. METHODS Ten subjects performed simple and choice reaction time tests (SRT and CRT, respectively) at ground level for 40 min (20 min normoxic, 20 min hyperoxic, randomly assigned), 3048 m (10,000 ft) for 75 min (15 min hyperoxic, 60 min hypoxic), 4572 m (15,000 ft) for 60 min (15 min hyperoxic, 45 min hypoxic), and 6096 m (20,000 ft) for 35 min (15 min hyperoxic, 20 min hypoxic). SRT and CRT tests were also conducted at ground level 1 h after normoxic rest (recovery) to assess any recovery time effect on these psychomotor tasks. RESULTS Total response time (TRT) significantly increased by 15 ms to 25 ms at all three altitudes for both the SRT and CRT tasks. At and below 4572 m, the performance changes were gradual over the duration of the exposures, whereas at 6096 m these changes were immediate. After 1 h, no performance decrement was measured. There was no statistical evidence that ground-level performance on these tasks was improved in hyperoxic vs. normoxic conditions. DISCUSSION Results suggest mild decrements in reaction time due to hypoxia may occur as low as 3048 m (10,000 ft) while hyperoxia showed no positive effect on accuracy or reaction time at ground level or higher when performing simple and choice psychomotor reaction tasks.Dart T, Gallo M, Beer J, Fischer J, Morgan T, Pilmanis A. Hyperoxia and hypoxic hypoxia effects on simple and choice reaction times. Aerosp Med Hum Perform. 2017; 88(12):1073-1080.