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Elevated Environmental Carbon Dioxide Exposure Confounding Physiologic Events in Aviators?

Chad T Andicochea¹, Matthew E Henriques², Joel Fulkerson³

¹Naval Medical Center, Department of Emergency Medicine, 34800 Bob Wilson Dr., San Diego, CA 92134.

Military Medicine

|May 1, 2019

Summary

Pre-flight exposure to elevated carbon dioxide (CO2) may be linked to physiological events (PEs) and decompression sickness (DCS) in military aviators. This case series suggests CO2

Keywords:

Decompression sickness Physiologic event aviation medicine carbon dioxide decompression illness

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Area of Science:

Aviation physiology
Aerospace medicine
Environmental health

Background:

Physiological events (PEs) pose significant risks to US military aviation safety and mission readiness.
Existing research has not established a link between pre-flight carbon dioxide (CO2) exposure and decompression sickness (DCS) in aviators.

Purpose of the Study:

To investigate a potential association between pre-flight carbon dioxide (CO2) exposure and physiological events (PEs) in military aviators.
To explore the role of indoor air quality, specifically elevated CO2 levels, in the development of altitude-related physiological events.

Main Methods:

A case series of six military aviators experiencing PEs after a rapid decompression event (RDE) with symptoms consistent with type II DCS.
Retrospective review of flight data and environmental factors, including pre-flight indoor air quality and measured CO2 levels.
Comparison with three asymptomatic aviators exposed to a similar RDE.

Main Results:

Affected aviators with PEs consistent with DCS were found to have been exposed to elevated CO2 levels due to poor pre-flight indoor air quality.
Asymptomatic aviators exposed to the same RDE had been in a well-ventilated environment with normal CO2 levels.
All RDEs occurred in tactical jet aircraft at an average altitude of 35,600 feet MSL.

Conclusions:

This case series suggests a potential role for elevated pre-flight CO2 exposure in the development of altitude DCS in aviators.
Proposed mechanisms include CO2's direct involvement in emboli gas composition and induction of a pro-inflammatory cascade.
Further research is warranted to explore the relationship between environmental CO2 exposure and the risk of DCS in aviators.