Fitness to Fly Testing in Patients with Congenital Heart and Lung Disease

Spoorenberg, Mandy E; Oord, Marieke H.A.H. Van den; Meeuwsen, Ted; Takken, Tim

doi:10.3357/amhp.4408.2016

Cited by 14 publications

(12 citation statements)

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“…Patients with normal physiology tend to tolerate a hypobaric airplane environment well [9, 10]; however concern exists for patients with existing pulmonary or cardiac or hematological disease and decompensation in this environment [11–15]. Normal respiratory changes to increasing altitude include increased minute ventilation through hyperventilation [16].…”

Section: Discussionmentioning

confidence: 99%

In-Flight Hypoxemia in a Tracheostomy-Dependent Infant

Quevreaux

Cropsey

2017

Case Reports in Anesthesiology

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Millions of passengers board commercial flights every year. Healthcare providers are often called upon to treat other passengers during in-flight emergencies. The case presented involves an anesthesia resident treating a tracheostomy-dependent infant who developed hypoxemia on a domestic flight. The patient had an underlying congenital muscular disorder and was mechanically ventilated while at altitude. Although pressurized, cabin barometric pressure while at altitude is less than at sea level. Due to this environment patients with underlying pulmonary or cardiac pathology might not be able to tolerate commercial flight. The Federal Aviation Administration (FAA) has mandated a specific set of medical supplies be present on all domestic flights in addition to legislature protecting “Good Samaritan” providers.

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Section: Discussionmentioning

confidence: 99%

In-Flight Hypoxemia in a Tracheostomy-Dependent Infant

Quevreaux

Cropsey

2017

Case Reports in Anesthesiology

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“…Multiple studies suggest that the hypoxic challenge test (exposure to 15% oxygen in nitrogen) correlates better with in-flight hypoxia than preflight oximetry, forced expiratory volume in 1 second, or the commonly used 50-m test (ability to walk 50 m). [87][88][89] However, the hypoxic challenge test is not routine or commonly available. A reasonable estimate of need for in-flight oxygen can use published equations and a passenger's ground-level PaO 2 and PaCO 2 measurements.…”

Section: Prevention Of Imesmentioning

confidence: 99%

In-Flight Medical Emergencies

Martin‐Gill

Doyle

Yealy

2018

JAMA

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n-flight medical emergencies (IMEs) are unique events for which traveling physicians, nurses, and other health care professionals may render medical assistance. Cruising at 35 000 ft with limited medical equipment, often hours away from the closest medical facility, creates an unfamiliar care challenge for many health care professionals. This clinical review focuses on IME data and offers guidance to assist medical professionals who may encounter these events using both literature and the authors' insights providing airline care guidance for IMEs. MethodsA literature search was conducted in MEDLINE using PubMed for English-only articles published between January 1, 1990, and June 2, 2018, using the terms air emergency, air emergencies, air passenger, air travel, aircraft, airline, aviation, commercial air, flight, and fitness to fly (n = 14 842). Scanning the titles to identify appropriateness and searching bibliographies yielded the final list of relevant articles (n = 765). Each article was assessed for completeness of data reporting and importance to management and prevention of IMEs. Based on this assessment, a total of 317 articles were included in the review. Frequency data were extracted and means and 95% confidence intervals were calculated when appropriate. Observations EpidemiologyThe estimated prevalence of IMEs is 1 in 604 flights based on a review of 11 920 requested ground consultations from 5 large IMPORTANCE In-flight medical emergencies (IMEs) are common and occur in a complex environment with limited medical resources. Health care personnel are often asked to assist affected passengers and the flight team, and many have limited experience in this environment.OBSERVATIONS In-flight medical emergencies are estimated to occur in approximately 1 per 604 flights, or 24 to 130 IMEs per 1 million passengers. These events happen in a unique environment, with airplane cabin pressurization equivalent to an altitude of 5000 to 8000 ft during flight, exposing patients to a low partial pressure of oxygen and low humidity. Minimum requirements for emergency medical kit equipment in the United States include an automated external defibrillator; equipment to obtain a basic assessment, hemorrhage control, and initiation of an intravenous line; and medications to treat basic conditions. Other countries have different minimum medical kit standards, and individual airlines have expanded the contents of their medical kit. The most common IMEs involve syncope or near-syncope (32.7%) and gastrointestinal (14.8%), respiratory (10.1%), and cardiovascular (7.0%) symptoms. Diversion of the aircraft from landing at the scheduled destination to a different airport because of a medical emergency occurs in an estimated 4.4% (95% CI, 4.3%-4.6%) of IMEs. Protections for medical volunteers who respond to IMEs in the United States include a Good Samaritan provision of the Aviation Medical Assistance Act and components of the Montreal Convention, although the duty to respond and legal protections vary across countries. Medical vol...

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“…3,4 Commercial flights expose individuals to a lower atmospheric pressure and consequently to a lower oxygen content, 2 as passenger cabins of commercial aircraft at maximal cruising altitude are pressurized to an altitude equivalent of 2438 m (8000 feet), 1,3,[5][6][7] which is equivalent to breathing 15% oxygen at sea level. [3][4][5][6][7][8][9][10] This altitude hypobaric hypoxia can be tolerated in healthy individuals, but may cause severe hypoxemia in patients with pulmonary disease. 3,10-14 CF-patients are therefore prone to a substantial and unsafe reduction in the partial arterial oxygen pressure (PaO2) during the flight 1,12 that may lead to a severe respiratory decompensation.…”

Section: Introductionmentioning

confidence: 99%

“…15 The Aerospace Medical Association 2 and British Thoracic Society (BTS) 4 recommend to perform a hypoxic altitude simulation test (HAST) to assess whether patients need in-flight oxygen supplementation. The HAST is considered the gold standard 11 and it can be done by artificially reducing inspired oxygen to similar levels as those experienced at 2438 m (8000 feet) for 20 min by either reducing the fraction of inspired oxygen to 15% 1,4,7,11 or by reducing atmospheric pressure to 565 Torr (75 kPa) in a hypobaric chamber. 4,11 The normobaric HAST is usually the preferred technique, as it is more accessible and inexpensive than the HAST performed in a hypobaric chamber.…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Normobaric Hypoxia Altitude Simulation Test and Altitude Hypoxia Predictive Equations in Cystic Fibrosis Patients

Costa

Barros

Rodrigues

et al. 2019

Preprint

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Background:The Hypoxia Altitude Simulation Test (HAST) is the Gold Standard to evaluate hypoxia in response to altitude and to decide on in-flight requirements for oxygen supplementation. Several equations are available to predict PaO2 in altitude (PaO2alt), but it remains unclear whether their predictive value is equivalent. We aimed to compare the results obtained by the available methods in a population of cystic fibrosis (CF) adults. Methods: Eighty-eight adults (58 healthy controls and 30 CF patients) performed a spirometry followed by an HAST. HAST results were compared with the predicted PaO2alt made by five equations: 1 st : PaO2alt= 0,410 x PaO2ground + 1,7652; 2 nd : PaO2alt= 0,519 x PaO2ground + 11,855 x FEV1 (L) -1,760; 3 rd : PaO2alt= 0,453x PaO2ground + 0,386 x FEV1 (%) + 2,44; 4 th : PaO2alt= 0,88 + 0,68 x PaO2ground; 5 th : PaO2alt= PaO2ground -26,6. Results: None of the controls required in-flight oxygen neither by HAST or by the five predictive equations. Eleven CF-patients had PaO2alt < 50 mmHg, accessed by HAST. The positive predictive value was 50% (1 st ), 87.5% (2 nd and 3 rd ), 77.78% (4 th ) and 58.33% (5 th ). Areas under the curve were 78.95% (1 st ), 84.69%(2 nd ), 88.04% (3 rd ) and 78.95% (4 th and 5 th ). FEV1 and PaO2ground were correlated with HAST results. Conclusions: The 3rd equation gave the best predictions in comparison with results obtained by HAST. However, because the individual differences found were substantial for all equations, we still recommend performing a HAST whenever possible to confidently access in-flight hypoxia and the need for oxygen.

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Fitness to Fly Testing in Patients with Congenital Heart and Lung Disease

Cited by 14 publications

References 0 publications

In-Flight Hypoxemia in a Tracheostomy-Dependent Infant

In-Flight Hypoxemia in a Tracheostomy-Dependent Infant

In-Flight Medical Emergencies

Comparison Between Normobaric Hypoxia Altitude Simulation Test and Altitude Hypoxia Predictive Equations in Cystic Fibrosis Patients

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