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Risk of Reduced Crew Health and Performance Due to Hypoxia


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Preparations for Next Moonwalk Simulations Underway (and Underwater)

astronauts go through a "pre-breathing" period before eva
Astronauts Michael R. (Rich) Clifford and Linda M. Godwin, the assigned space-walking mission specialists for STS-76, go through a “pre-breathing” period on the Space Shuttle Atlantis’ middeck. This practice is normal procedure for space-walkers in preparation for their Extravehicular Activity (EVA) and the wearing of their Extravehicular Mobility Units (EMU). The photograph was taken with a 35mm camera by one of the crew members.

Human exploration missions will require robust, flexible Extravehicular Activity (EVA) architecture protocols that include the use of a reduced-pressure cabin atmosphere enabling staged denitrogenation. Use of this atmosphere could result in compromised health and performance to the crewmember due to exposure to mild hypobaric hypoxia; of most concern are the potential effects on the increased intracranial pressure, visual impairment, cognitive performance, sensorimotor dysfunction, oxidative damage, and sleep quality. In addition to hypobaric hypoxia associated with staged denitrogenation, there are additional factors that can result in hypoxic exposure to the crewmember, such as cabin depressurization, Environmental Control, and Life Support System (ECLSS) failure, toxic exposure, or crewmember illness/injury.

astronauts test a Personal Cabin Pressure Altitude Monitor
Jan Zysko (left) and Rich Mizell (right) test a Personal Cabin Pressure Altitude Monitor in an altitude chamber at Tyndall Air Force Base in Florida. Zysko invented the pager-sized monitor that alerts wearers of a potentially dangerous or deteriorating cabin pressure altitude condition, which can lead to life-threatening hypoxia. Zysko is chief of the KSC Spaceport Engineering and Technology directorate’s data and electronic systems branch. Mizell is a Shuttle processing engineer. The monitor, which has drawn the interest of such organizations as the Federal Aviation Administration for use in commercial airliners and private aircraft, was originally designed to offer Space Shuttle and Space Station crew members added independent notification about any depressurization
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+ Hypoxia Risk DAG and Narrative (PDF)

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+ Risk of Reduced Crew Health and Performance Due to Hypoxia

+ 2015 November Evidence Report (MSWord)

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Last Updated
Mar 11, 2025
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Robert E. Lewis

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      Human System Risk Management Plan – JSC-66705 NASA Health and Medical Technical Authority (HMTA) Implementation – NPR 7120.11A NASA Space Flight Program and Project Management Requirements – NPR 7120.5 Human System Risk Board Management Office
      The HSRB Risk Management Office governs the execution of the Human System Risk management process in support of the HSRB. It is led by the HSRB Chair, who is also referred to as the Risk Manager.
      Risk Custodian Teams
      Along with the Human System Risk Manager, a team of risk custodians (a researcher, an operational researcher or physician, and an epidemiologist, who each have specific expertise) works together to understand and synthesize scientific and operational evidence in the context of spaceflight, identify and evaluate metrics for each risk in order to communicate the risk posture to the agency.
      Directed Acyclic Graphs 
      Summary
      The HSRB uses Directed Acyclic Graphs (DAG), a type of causal diagramming, as visual tools to create a shared understanding of the risks, improve communication among those stakeholders, and enable the creation of a composite risk network that is vetted by members of the NASA community and configuration managed (Antonsen et al., NASA/TM– 20220006812). The knowledge captured is the Human Health and Performance community’s knowledge about the causal flow of a human system risk, and the relationships that exist between the contributing factors to that risk.
      DAGs are:
      Intended to improve communication between: Managers and subject matter experts who need to discuss human system risks Subject matter experts in different disciplines where human system risks interact with one another in a potentially cumulative fashion Visual representations of known or suspected relationships Directed – the relationship flows in one direction between any two nodes Acyclic – cycles in the graph are not allowed Example of a Directed Acyclic Graph. This is a simplified illustration of how and the individual, the crew, and the system contribute to the likelihood of successful task performance in a mission. Individual readiness is affected by many of the health and performance-oriented risks followed by the HSRB, but the readiness of any individual crew is complemented by the team and the system that the crew works within. Failures of task performance may lead to loss of mission objectives if severe.NASA View Larger (Example of a Directed Acyclic Graph) Image
      Details
      At NASA, the Human System Risks have historically been conceptualized as deriving from five Hazards present in the spaceflight environment. These are: altered gravity, isolation and confinement, radiation, a hostile closed environment, and distance from Earth. These Hazards are aspects of the spaceflight environment that are encountered when someone is launched into space and therefore are the starting point for causal diagramming of spaceflight-related risk issues for the HSRB.
      These Hazards are often interpreted in relation to physiologic changes that occur in humans as a result of the exposure; however, interaction between human crew (behavioral health and performance), which may be degraded due to the spaceflight environment – and the vehicle and mission systems that the crew must operate – can also be influenced by these Hazards.
      Each Human System Risk DAG is intended to show the causal flow of risk from Hazards to Mission Level Outcomes. As such, the structure of each DAG starts with at least one Hazard and ends with at least one of the pre-defined Mission Level Outcomes. In between are the nodes and edges of the causal flow diagrams that are relevant to the Risk under consideration. These are called ‘contributing factors’ in the HSRB terminology, and include countermeasures, medical conditions, and other Human System Risks. A graph data structure is composed of a set of vertices (nodes), and a set of edges (links). Each edge represents a relationship between two nodes. There can be two types of relationships between nodes: directed and undirected. For example, if an edge exists between two nodes A and B and the edge is undirected, it is represented as A–B, (no arrow). If the edge were directed, for example from A to B, then this is represented with an arrow (A->B). Each directed arrow connecting one node to another on a DAG indicates a claim of causality. A directed graph can potentially contain a cycle, meaning that, from a specific node, there exists a path that would eventually return to that node. A directed graph that has no cycles is known as acyclic. Thus, a graph with directed links and no cycles is a DAG.  DAGs are a type of network diagram that represent causality in a visual format.
      DAGs are updated with the regular Human System Risk updates generally every 1-2 years. Approved DAGs can be found in the NASA/TP 20220015709 below or broken down under each Human System Risk.
      Documents
      Directed Acyclic Graph Guidance Documentation – NASA/TM 20220006812 Directed Acyclic Graphs: A Tool for Understanding the NASA Human Spaceflight System Risks – NASA/TP 20220015709 Publications
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