Predicting the Need for Supplemental Oxygen During Airline Flight in Patients with Chronic Pulmonary Disease: A Comparison of Predictive Equations and Altitude Simulation

Bradi, Ana C.; Faughnan, Marie E.; Stanbrook, Matthew B.; Deschenes-Leek, Eva

doi:10.1155/2009/371901

Cited by 19 publications

(19 citation statements)

References 19 publications

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“…Various proposed equations and single sea-level variables have proven not to predict in-flight hypoxaemia with a satisfactory precision 1 3–5 16 22. Several authors have suggested that exercise-related outcomes may be useful discriminators 4 5 14 24 25.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is important to minimise the number of patients needing referral to HAST. Prediction equations, sea level PaO 2 and spirometric values alone have proven not to be reliable tools for estimating the risk of severe in-flight hypoxaemia 1 3–5 16 22. In an algorithm published by the British Thoracic Society (BTS), sea-level oxygen saturation by pulse oximetry (SpO 2 SL ) was used as a discriminating variable,13 and it was recently confirmed that a SpO 2 SL <92% seems to be an appropriate cut-off value for recommending in-flight supplemental oxygen without further pre-flight evaluation 23.…”

Section: Introductionmentioning

confidence: 99%

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Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation

Edvardsen

Akerø

Christensen

et al. 2012

Thorax

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BackgroundThe reduced pressure in the aircraft cabin may cause significant hypoxaemia and respiratory distress in patients with chronic obstructive pulmonary disease (COPD). Simple and reliable methods for predicting the need for supplemental oxygen during air travel have been requested. Objective To construct a pre-flight evaluation algorithm for patients with COPD. Methods In this prospective, cross-sectional study of 100 patients with COPD referred to hypoxia-altitude simulation test (HAST), sea level pulse oximetry at rest (SpO 2 SL ) and exercise desaturation (SpO 2 6MWT ) were used to evaluate whether the patient is fit to fly without further assessment, needs further evaluation with HAST or should receive in-flight supplemental oxygen without further evaluation. HAST was used as the reference method. Results An algorithm was constructed using a combination of SpO 2 SL and SpO 2 6MWT . Categories for SpO 2 SL were >95%, 92e95% and <92%, the cut-off value for SpO 2 6MWT was calculated as 84%. Arterial oxygen pressure (PaO 2 HAST ) <6.6 kPa was the criterion for recommending supplemental oxygen. This algorithm had a sensitivity of 100% and a specificity of 80% when tested prospectively on an independent sample of patients with COPD (n¼50). Patients with SpO 2 SL >95% combined with SpO 2 6MWT $84% may travel by air without further assessment. In-flight supplemental oxygen is recommended if SpO 2 SL ¼92e95% combined with SpO 2 6MWT <84% or if SpO 2 SL <92%. Otherwise, HAST should be performed. Conclusions The presented algorithm is simple and appears to be a reliable tool for pre-flight evaluation of patients with COPD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation

Edvardsen

Akerø

Christensen

et al. 2012

Thorax

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“…Decreased exercise capacity has been reported in heart failure passengers at high altitudes . Oxygen supplementation is generally recommended in passengers with New York Heart Association (NYHA) class III/IV symptoms, passengers with baseline arterial oxygen saturation of <92%, and those who use oxygen at sea level . Severe decompensated heart failure is an absolute contraindication to air travel .…”

Section: Air Travel and Heart Diseasementioning

confidence: 99%

“…27 Oxygen supplementation is generally recommended in passengers with New York Heart Association (NYHA) class III/IV symptoms, passengers with baseline arterial oxygen saturation of <92%, and those who use oxygen at sea level. 1,2,10,17,28 Severe decompensated heart failure is an absolute contraindication to air travel. 17 Minor hemodynamic alteration and decrease in blood flow has been reported in several cases.…”

Section: Heart Failurementioning

confidence: 99%

Navigating air travel and cardiovascular concerns: Is the sky the limit?

Hammadah

Kindya

Allard-Ratick

et al. 2017

Clinical Cardiology

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As the population ages and our ability to care for patients with cardiac disease improves, an increasing number of passengers with cardiovascular conditions will be traveling long distances.Many have had cardiac symptoms, recent interventions, devices, or surgery. Air travel is safe for most individuals with stable cardiovascular disease. However, a thorough understanding of the physiologic changes during air travel is essential given the potential impact on cardiovascular health and the risk of complications in passengers with preexisting cardiac conditions. It is important for clinicians to be aware of the current recommendations and precautions that need to be taken before and during air travel for passengers with cardiovascular concerns. | INTRODUCTIONMore than 2.75 billion passengers travel globally by air each year. As the population ages and our ability to care for passengers with cardiac disease improves, an increasing number of people with cardiovascular disease will be utilizing air travel. Among these individuals, some have had pacemakers or automatic defibrillators implanted, recent revascularization, or surgery that might predispose to deep venous thrombosis (DVT). 1-3 Also, the use of air medical transport services provided by private and insurance-affiliated companies has risen significantly over the past 15 years. 4 In the largest observational study of medical emergencies during air travel, which analyzed data of 744 million airline passengers between 2008 and 2010, the medical incidence rate was reported to be 1.6 per 100 000 passengers, with medical deaths occurring in 36 passengers. 3 Cardiac causes represent 8% of the medical emergencies, whereas cardiac arrest was the most common cause of medical death (31/36) and flight diversion. 3,5 Myocardial ischemia is the most common cause of cardiac events during air travel. 6 DVT is another concern for people who fly long distances, with incidence reaching up to 5.4% in high-risk groups flying an average of 12.4 hours. 2 The risk of venous thromboembolism (VTE) is about 3 times higher in passengers on long distance flights than in the general population. 7Air travel is safe for most individuals. Importantly, a thorough understanding of the physiologic changes during air travel is essential for every physician, as special precautions are needed for higher-risk passengers. | PHYSIOLOGICAL CHANGES DURING AIR TRAVELMultiple factors can affect cardiovascular health during air travel, including decreased atmospheric pressure, decreased humidity, gas expansion, prolonged immobility, and increased physical and emotional stress.Most commercial aircraft fly at an elevation somewhere between 22 000 and 44 000 feet above sea level (cruising altitude), with a corresponding decline in partial pressure of inspired oxygen of approximately 4 mm Hg per 1000 feet above sea level. 8 This altitude is associated with an approximate 65% to 85% decrease in atmospheric air pressure and a 60% to 90% decrease in partial pressure of inspired oxygen in comparison with sea lev...

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“…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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Predicting the Need for Supplemental Oxygen During Airline Flight in Patients with Chronic Pulmonary Disease: A Comparison of Predictive Equations and Altitude Simulation

Abstract: Current screening recommendations for determining which patients require formal assessment of oxygen during flight are inadequate. Predictive equations based on sea level variables provide poor estimates of PaO(2) measured during altitude simulation.

Cited by 19 publications

References 19 publications

Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation

Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation

Navigating air travel and cardiovascular concerns: Is the sky the limit?

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

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