title: The effect of staged decompression while breathing 100% oxygen on altitude decompression sickness.
abstract: BACKGROUND
  Space Shuttle extravehicular activity (EVA) requires decompression from sea level pressure (14.7 psia) to a 4.3 psia (30,300 ft) pressure suit. The transition currently involves altering the shuttle atmosphere to allow shirt-sleeve denitrogenation to occur during a 12 to 36-h staged decompression (SD) at 10.2 psia (9,800 ft) with an oxygen-enriched breathing gas (26.5% oxygen, 73.5% nitrogen). The denitrogenation provides protection from decompression sickness (DCS) during EVA in a 4.3 psia pressure suit. Our goal was to determine the highest altitude at which SD while breathing 100% oxygen (SD100) could provide effective protection from development of DCS symptoms after further decompression to 29,500 ft (4.5 psia).
  
  
  METHODS
  There were 30 male subjects exposed to at least 6 of 11 conditions in random order on successive months to 29,500 ft for 4 h while performing mild exercise and being monitored for venous gas emboli (VGE) with an echo-imaging system. The subjects received 15 min of ground-level (GL) preoxygenation and an additional 60 or 120 min of SD100 at one of four altitudes between 8,000 ft (10.9 psia) and 18,000 ft (7.3 psia). Control exposures followed a 75- or 135-min ground-level preoxygenation.
  
  
  RESULTS
  During SD100, one case of DCS occurred at 18,000 ft, but not at lower staging altitudes. Higher levels of VGE were observed during SD100 at 18,000 ft than during SD100 at any lower altitude.
  
  
  CONCLUSIONS
  Staged decompression at 16,000 ft and below results in decompression risk during subsequent decompression to 29,500 ft similar to that following equivalent periods of ground-level preoxygenation.
authors.affiliation: Air Force Research Laboratory in San Antonio, TX, USA. james.webb@brooks.af.mil
authors.forename: J T
authors.initials: JT
authors.lastname: Webb
authors.forename: A A
authors.initials: AA
authors.lastname: Pilmanis
authors.forename: N
authors.initials: N
authors.lastname: Kannan
authors.forename: R M
authors.initials: RM
authors.lastname: Olson
mesh_terms: D000532:Altitude Sickness / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003664:Decompression / Q000379:methods*; D003665:Decompression Sickness / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D018478:Extravehicular Activity / Q000009:adverse effects; D006801:Humans; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors