Assessment of oxygen supplementation during air travel.

Cramer, Derek; Ward, Simon; Geddes, Duncan M.

doi:10.1136/thx.51.2.202

Cited by 62 publications

(55 citation statements)

References 2 publications

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“…Because of the relative inaccessability of hypobaric chambers the development of a simple HIT which can be used in respiratory function laboratories for the preflight assessment of patients is potentially beneficial. To ensure the protocol would be applicable in routine laboratories, the use of a plethysmograph [3] and expensive cylinders of hypoxic gas mixtures was avoided. The simple and elegant method of VOHRA and KLOCKE [11] using a Venturi mask supplied with nitrogen was therefore adopted.…”

Section: Discussionmentioning

confidence: 99%

Laboratory assessment of fitness to fly in patients with lung disease: a practical approach

Robson

Hartung

2000

Eur Respir J

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To identify patients with respiratory disease, who may be at risk of developing respiratory distress during commercial air travel, a hypoxia inhalation test (HIT) can be performed. This paper reports our experience of using such a test combined with an interpretation algorithm in a routine respiratory function laboratory. Twenty‐eight patients were studied. Baseline oxygen saturation (Sa,O2) was measured using a pulse oximeter. If Sa,O2 was <90% no HIT was performed and the patient was assessed as unfit for air travel. If baseline Sa,O2 was ≥90% an HIT was performed by the patient breathing through a 35% Venturi mask supplied with 100% nitrogen which reduced inspiratory oxygen fraction to 15.1±0.2%. Results were interpreted using a locally derived algorithm, and validation was attempted using a questionnaire to investigate subsequent symptoms during travel. All patients tolerated the assessment well. Twenty‐two patients were assessed as “fit to fly” with a further two patients “fit to fly with supplemental O2”. Four patients were considered unfit to fly. Hypoxic response could not be predicted from either forced expiratory volume in one second, or pretest saturation. Validation of such protocols is difficult, but the hypoxia inhalation test may be a useful tool for predicting hypoxia during air travel in patients with chronic respiratory disease.

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Section: Discussionmentioning

confidence: 99%

Laboratory assessment of fitness to fly in patients with lung disease: a practical approach

Robson

Hartung

2000

Eur Respir J

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“…Pressurised aircraft do not maintain a sea level pressure during flight for practical reasons. During commercial flights most cabins are pressurised to an equivalent altitude of 5000-8000 ft, which equates to an inspired oxygen fraction of 0.17-0.15 at sea level [5]. Current US Federal Aviation Regulations specify that pressurised cabins must provide a cabin pressure altitude of not more than 8000 ft (2440 m) at the maximum operating altitude of the ............................................................................................................................................................................................................... (FAA, 1996), in order to maintain the partial pressure of oxygen [12].…”

Section: Discussionmentioning

confidence: 99%

“…Many flights are also of a longer duration than previously, up to 16 h non-stop [1,2]. The reduction in the fraction of inspired oxygen at altitude leads to a reduction in oxygen saturation (S p O 2 ) in both healthy passengers and in those with coexisting medical conditions during actual and simulated aeromedical flights [3][4][5][6][7].…”

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confidence: 99%

The effect of high altitude commercial air travel on oxygen saturation

Humphreys

Deyermond²,

Bali³

et al. 2005

Anaesthesia

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SummaryAir travel has increased steadily over the last decade, and its effect on the health of passengers has been the subject of much debate. There is a paucity of evidence on the effects of air travel on oxygen saturation in general populations. The peripheral oxygen saturation and pulse rate of 84 passengers, aged 1-78 years, were measured by pulse oximetry at round level and altitude during air travel. There was a statistically significant reduction in oxygen saturation in all passengers travelling long haul and short haul flights (p < 0.05). The mean [range] (SD) SpO 2 for all flights at ground level was 97% [93-100] (1.33) and at cruising altitude 93% [85-98] (2.33). Fifty-four per cent of passengers had SpO 2 values of 94% or less at cruising altitude. This is a value which may prompt physicians to administer supplemental oxygen in hospital patients.

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“…CRAMER et al [18] used a modified body plethysmograph as an exposure chamber, a method that has the advantage of eliminating the need for the patient to breathe through a mask, which some patients find uncomfortable or inhibiting. The FI,O 2 within the exposure chamber needs to be closely monitored to ensure that it remains within the desired range.…”

Section: Methods Of Predicting Hypoxiamentioning

confidence: 99%

Problems of air travel for patients with lung disease: clinical criteria and regulations

Robson

2006

Breathe

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Key pointsCommercial aircraft have a hypoxic environment, equivalent to an altitude of 2,438 m (8,000 ft) above sea level.Normal subjects and the majority of respiratory patients can tolerate this without symptoms. In practice, medical diversions for respiratory problems are very rare.The tendency of individual patients to become hypoxic in these conditions cannot be predicted with accuracy from sea-level oxygen saturation or spirometry.Hypoxic challenge may be used to simulate the inflight environment, to predict hypoxaemia and to assess the effectiveness of inflight oxygen.Most airlines, with adequate warning, can provide oxygen at 2 or 4 litres per minute for respiratory patients.While it may be possible to predict hypoxia during flight, there are no means of predicting symptoms or actual risk of harm during air travel.Educational aimsTo identify the potential problems that patients with chronic respiratory conditions may encounter during air travel.To recognise that guidelines have been developed from a number of sources to assist doctors involved in assessing a patient who is considering air travel.To make clinicians aware of the different methods of hypoxic challenge that have been developed to help with the clinical assessment of patients.To highlight that many patients with chronic lung disease are capable of air travel without developing significant hypoxia, but to raise awareness about which patients are likely to be at risk.To discuss the potential difficulties that may arise for the patient when they are arranging inflight oxygen.SummaryDoctors are frequently asked by patients with chronic lung disease if they are fit to fly. As commercial flights are not pressurised to sea level, there is a reduction in partial pressure of oxygen (PO2), which may result in significant hypoxia in otherwise asymptomatic patients.A number of different assessment methods have been developed to assess flight fitness and several professional organisations have developed guidelines to help doctors give informed advice.Patients who become significantly hypoxic during a flight assessment may still be able to travel with supplemental oxygen. However, the provision of supplemental oxygen is dependent on individual airline policy and considerable variations in policy have been recorded.This review aims to give a brief overview of air travel for patients with lung disease, including physiology, guidelines, assessing fitness to fly and oxygen supplementation.

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Assessment of oxygen supplementation during air travel.

Cited by 62 publications

References 2 publications

Laboratory assessment of fitness to fly in patients with lung disease: a practical approach

Laboratory assessment of fitness to fly in patients with lung disease: a practical approach

The effect of high altitude commercial air travel on oxygen saturation

Problems of air travel for patients with lung disease: clinical criteria and regulations

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