#40 CCT Goes to the Moon w/ Astronaut Dr. Shawna Pandya
On this end-of-year episode, Nick & Cyrus boldly go where no Critical Care Podcasters have gone before - into space! Join us, as we adventure into the great beyond with astronaut extraordinaire, Dr. Shawna Pandya - the first female Canadian commercial astronaut, who also happens to be a rural emergency medicine physician among SO many other things. We spend an hour with her discussing space physiology, medical applications of space tech, chatting about ICU corollaries, her experiences training for her upcoming mission, and exploring the challenges facing space exploration in 2025 and beyond. Hop aboard and and enjoy this exciting content and let us know what you think. This super accessible episode is loads of fun for ICU junkies and space-nerds alike so kick back, give it a listen, and as always, let us know what you think!
Dr Shawna Pandya
Dr. Shauna Pandya is the first named female commercial Canadian astronaut, and will be flying to space with the Virgin Galactic Delta class of spacecraft with the International Institute for Astronautical Sciences (IIAS). She is also a physician, aquanaut, skydiver, pilot-in-training, VP Immersive Medicine with Luxsonic Technologies, Director of IIAS’ Space Medicine Group, Executive Director of the IIAS Flight Opportunities Program, and Chief of Space Medicine at the Advanced Spacelife Research Institute. Dr. Pandya was on the first crew to test a commercial spacesuit in zero-gravity in 2015. She earned her aquanaut designation on the 2019 NEPTUNE (Nautical Experiments in Physiology, Technology and Underwater Exploration) mission, and completed a second aquanaut mission, NEP2NE, in May 2023, for a total of 11 days, 10 nights underwater.
Follow her at @shawnapandia
Dr. Shawna Pandya, MD
Challenges of Space Medicine
Understanding extremes of physiology is crucial for ICU practitioners, and there are few environments more extreme than space. In some cases understanding the medical challenges of the space-flight environment can provide useful insights for the ground.
Long-duration space missions (such as those to Mars) pose significant additional health risks to astronauts. The risks include prolonged exposure to microgravity, radiation, and isolation.
Unique challenges of the spaceflight environment include Spaceflight associated neuro-ocular syndrome (SANS), which may pose a larger challenge on longer duration missions.
Resource limited environments
Austere environments have unique challenges:
Severe weight and volume limitations on medical supplies - need to have versatile tools (ultrasound, smartphones, etc) that can be used for many different purposes.
Need to train for everything - crews need to be broadly trained to treat both common and serious emergencies
Difficulty of retaining skills - longer missions make skills retention more difficult. Tools like virtual reality may make training and refresher easier.
Medication expiration - most medications would expire before the end of a Mars mission.
Need to handle emergencies independently - this is especially true for Mars, where a 20+ minute light delay and 2 weeks of communication blackout mean crews will need to be highly autonomous.
Inability to return to earth for medical emergencies - this is especially true for future Mars missions, where because of orbital mechanics, the crew is committed to a ~1000 day mission following Trans-Mars Injection (TMI) burn.
This imposes the requirements that astronauts:
Pack for everything
Prepare for everything
Train for everything
Approaches & technologies developed for austere environments in space may be applicable on Earth, for example telepresence POCUS used in rural communities, or virtual reality training used to train paramedics during the COVID19 pandemic.
Augmented Reality POCUS from Liao et al, BMC Education 2024
Microgravity
Astronauts (like ICU patients) are subject to significant muscle atrophy and bone density loss due to lack of resistance exercise.
Currently, astronauts perform 2+ hours of exercise per day to mitigate these effects. However pharmacological therapies are in development
Myostatin knockout mice also protected against loss of muscle and bone density.
ACVR2 mutant mice → countermeasure for muscle atrophy and bone loss
Mice injected with ACVR2/Fc decoy receptor were also significantly protected.
Could this someday be a useful therapy for astronauts on long missions or ICU patients subject to prolonged critical illness?
Radiation exposure
The Earth’s magnetic field and atmosphere protect us from radiation, however, with increasing altitude radiation exposure increases.
Astronauts are exposed to significant doses of ionizing radiation while in space:
Cosmic rays - charged particles (protons or atomic nuclei) traveling near the speed of light can impart significant energy to biological tissue.
Solar radiation - gamma rays and X-rays are also harmful. Solar flares and coronal mass ejections can increase the levels of solar radiation significantly.
Radiation exposure can cause long term health issues such as cataracts, cancer risk. Solar Particle Events (SPE) can cause acute radiation illness.
Approaches to mitigate the risks of radiation include novel shielding technologies, dietary and other therapies (e.g. antioxidants, radioprotectants) to enhance DNA repair.
Sleep disruption
Astronauts (like ICU patients and shift-workers) experience significant sleep disruption. One study found that astronauts sleep only about 6.5 hours per ”night” (a day-night cycle lasts 90 minutes on the ISS) and REM sleep was reduced by 50% compared to pre-flight.
Two studies reported that more than 70% of both shuttle and ISS astronauts use sleep medications during the flight missions, which hastened the approach of sleep but did not bring longer sleep duration. A rigorous controlled trial during space shuttle flights found that melatonin significantly improved sleep latency compared to placebo, but there was no difference in other sleep parameters.
Just like in ICUs, low tech improvements may be effective:
Environmental modifications to reduce ambient noise and light
Ear plugs
Eye shields
Scheduled sleep periods (e.g. ICU quiet time)
Control of light spectrum (e.g. blue light during daytime)
Immune Suppression
A recent analysis of 14 astronauts found that a 6 month exposure to space resulted in significant changes to the leukocyte transcriptome, with a marked decrease in immune gene expression.
Immune suppression in space could have signficant effects for longer missions.
Venous stasis and thrombosis
Recently, an astronaut developed internal jugular vein thrombosis while on the ISS. Microgravity may increase the risk for VTE due to decreases in blood flow, hemoconcentration, and changes in endothelial cell gene expression.
Psychological Stress
Space crews are carefully screened, however stress and isolation can have significant effects, especially on longer missions.
Benefits of Space Medicine in Terrestrial ICUs
Spin-In and Spin-Out technologies
Many technologies developed for spaceflight are now widely used on Earth, including in ICUs. This includes:
Telemetry monitoring - originally developed to monitor the health of astronauts in space. Now ubiquitous in hospitals.
Infrared ear thermometers → used to assess patients (and kids) quickly
Memory foam mattresses → prevents pressure injury
The Left Ventricle Assist Device (LVAD) was developed in collaboration between DeBakey and NASA, who helped to miniaturize the pump.
LASIK surgery - was developed using LIDAR technology originally designed for orbital rendezvous and docking.
Software based Pupillometers have been tested in zero-g
Bowflex machines - the Interim Resistive Exercise Device (IRED) was first used on the ISS as an alternative to transporting free weights
Freeze-dried foods - originally developed for astronauts as a shelf stable, light weight food that could be reconstituted using only room temperature water.
Improved solar panels - numerous technologies developed by NASA have improved the efficiency, decreased the cost, and improved the durability of solar panels.
Astroglide - In 1977 a new coolant was invented to improve the heat transfer in the cooling system of the space shuttle orbiter. Being water-soluable and non-toxic, the substance was repurposed and marketed as a personal lubricant.”
Technologies currently under development:
Telepresence medical systems
Virtual reality training systems
Smartwatch telemetry monitors
NASA publishes an annual report about technologies developed for spaceflight that are being used on Earth. Check out NASA Spinoff for more!
Importance of the space economy
Spaceflight is essential for many terrestrial industries: GPS for navigation (GPS also enables the precise timekeeping required in finance), satellites for global communication, weather satellites for forecasting & air travel.
The global space economy is rapidly growing. By 2030, the size of the space economy is estimated to be $1 trillion annually.
Space health startups are emerging as a new frontier.
Microgravity may enable to manufacture of novel pharmaceuticals.
Other novel technologies may benefit patients on Earth.