Hypercapnic Respiratory Acidosis During An In-Flight Oxygen Assessment
Patients with respiratory disease are at risk of excessive hypoxemia in the hypobaric commercial aircraft cabin environment, and the consensus is that this is easily corrected with supplementary oxygen. However, despite the risks of hypercapnia with increasing inspired oxygen in some patients being well established, this issue is not currently addressed in medical guidelines for air travel. A 76-yr-old woman with chronic type 2 respiratory failure underwent hypoxic challenge testing (HCT) to assess in-flight oxygen requirements. She is stable on home ventilation, and baseline arterial blood gases showed mild hypoxemia (Pao2 9.12 kPa), normal Paco2 (5.64 kPa) and pH (7.36) with 98% SpO2. HCT was performed delivering 15% FIo2 via a mask, and the patient desaturated to < 85%. HCT blood gases revealed significant hypoxemia (Pao2 < 6.6 kPa), indicating in-flight oxygen. Continuous oxygen at 2 L · min−1 via nasal cannula corrected the hypoxia, although Paco2 increased to 6.9 kPa with reduction in pH to the threshold of severe respiratory acidosis (pH 7.25). The patient was advised against flying due to hypoxemia during HCT and the precipitous drop in pH on oxygen. It is possible to hyperoxygenate patients with type 2 respiratory failure in flight with the minimum level of supplementary oxygen available on many aircraft. In these cases Paco2 and pH should be scrutinized during HCT before recommending in-flight oxygen. No current guidelines discuss the risk of hypercapnia from in-flight oxygen; it is therefore recommended that this be addressed in future revisions of medical air travel guidelines, should further research indicate it.
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Availability:
- Find a library where document is available. Order URL: http://worldcat.org/issn/23756314
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Supplemental Notes:
- Abstract reprinted with permission of the Aerospace Medical Association.
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Authors:
- Spurling, Kristofer J
- Moonsie, Ian K
- Perks, Joseph L
- Publication Date: 2016-2
Language
- English
Media Info
- Media Type: Print
- Features: References;
- Pagination: pp 144-147
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Serial:
- Aerospace Medicine and Human Performance
- Volume: 87
- Issue Number: 2
- Publisher: Aerospace Medical Association
- ISSN: 2375-6314
- EISSN: 2375-6322
- Serial URL: http://ingentaconnect.com/content/asma/asem
Subject/Index Terms
- TRT Terms: Air travel; Aviation safety; Case studies; Civil aircraft; Health care; In transit passenger services; Passenger compartments; Physical fitness; Respiratory system
- Uncontrolled Terms: Hypoxemia
- Subject Areas: Aviation; Safety and Human Factors;
Filing Info
- Accession Number: 01601862
- Record Type: Publication
- Files: TRIS
- Created Date: Jun 14 2016 9:15AM