title: An abrupt zero-preoxygenation altitude threshold for decompression sickness symptoms.
abstract: BACKGROUND
  The altitude threshold for decompression sickness (DCS) symptoms has been variously described as being 18,000 ft (5,487 m) to above 25,000 ft (7,620 m). Safety and efficiency of aerospace operations require more precise determination of the DCS threshold.
  
  
  METHODS
  Subjects were 124 males who were exposed to simulated altitudes (11 at 11,500 ft; 10 at 15,000 ft; 8 at 16,500 ft; 10 at 18,100 ft; 10 at 19,800 ft; 20 at 21,200 ft; 20 at 22,500 ft; 10 at 23,800 ft, and 25 at 25,000 ft) for 4 to 8 h. All breathed 100% oxygen beginning with ascent. Subjects were monitored for precordial venous gas emboli (VGE) and DCS symptoms. Probit curves representing altitude vs. incidence of DCS symptoms and VGE allowed estimation of respective risk.
  
  
  RESULTS
  VGE were first observed at 15,000 ft with increasing incidence at higher altitudes; over 50% at 21,200 ft and 70% or higher at 22,500 ft and above. The lowest altitude occurrence of DCS was a 5% incidence at 21,200 ft. At 22,500 ft, the DCS incidence abruptly climbed to 55%.
  
  
  CONCLUSIONS
  A 5% threshold for DCS symptoms was concluded to be 20,500 ft under the conditions of this study. The abrupt increase in DCS symptoms, with zero-preoxygenation exposure above 21,200 ft implies a need for reconsideration of current USAF and FAA altitude exposure guidance.
authors.affiliation: KRUG Life Sciences Inc., San Antonio, TX 78214, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Webb
authors.forename: A A
authors.initials: AA
authors.lastname: Pilmanis
authors.forename: R B
authors.initials: RB
authors.lastname: O'Connor
mesh_terms: D000337:Aerospace Medicine; D000531:Altitude; D003665:Decompression Sickness / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D004618:Embolism, Air / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D005080:Exercise Test; D006801:Humans; D015994:Incidence; D016013:Likelihood Functions; D008297:Male; D010102:Oxygen Inhalation Therapy; D012307:Risk Factors; D013997:Time Factors