Air travel - Air travel : Implications for patients with...

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Air travel : Implications for patients with pulmonary disease DM Seminar presented by: Dr. Vamsi Krishna SR, Pulmonary medicine, PGIMER
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Problems associated with Air Travel Over 1 billion people air travel each year world over. Passengers traveling by air are exposed to following risks: Exposure to high altitude Risk of DVT Spread of Infectious diseases
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Air travel : Pressurized cabins ? • Commercial aircraft are not pressurized to sea level, but to a relatively modest intermediate cabin altitude. (fuel efficient for jet engines and avoids much turbulence) • Aircraft cabin altitude can thus approach 2438 m (8000 ft) while the aircraft is flying at 11582 m (38000 ft). Cottrel JJ. Chest 1988;92:81-4
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Effects of altitude on Oxygenation At altitude of 8000 ft, partial pressure of oxygen falls to a level, equivalent to breathing oxygen at FiO 2 of 15.1% In a healthy individual PaO 2 falls to 53-64 mm Hg SpO 2 falls to 85-91%
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Magnitude of problem • 5% of commercial airline passengers were ambulatory patients with some illness including chronic obstructive pulmonary disease (COPD) Iglesias R. Aerosp Med 1974; 45: 204-206 • 10.2% of in-flight medical emergencies calls were respiratory in nature. Cottrel J.JAMA 1989; 262(12):1653-6 • 17% of respiratory in flight emergencies resulted in diversion of air craft and was 3 rd most common cause. Sirven JI. Neurology,2002;58:1739-44
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Magnitude of problem Dowdall N. BMJ 2000;321:1336-1337
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Gong H. Chest 1992;101;1104-1113
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Clinical strategy Aim :To maintain PaO 2 of >50 mm Hg during travel Target : High risk patients Preflight assessment of in-flight PaO 2 Oxygen supplementation to needy
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Preflight evaluation
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Who should be evaluated ? Severe COPD or asthma Severe restrictive disease, especially with hypoxemia Cystic fibrosis Recent Pneumothorax Pre-existing requirement for oxygen or ventilator support History of air travel intolerance with respiratory symptoms (dyspnea, chest pain, confusion or syncope) Risk of or previous venous thromboembolism Conditions worsened by hypoxemia (cerebro vascular disease, coronary artery disease, heart failure) Cases of Tuberculosis BTS 2004 recommendations
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Preflight evaluation Regression estimates of PaO2 Hypoxia Inhalation Test 6 minute walk test History & examination Spirometry SpO2 ABG
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Predicting PaO 2 PaO2 of 68 or 72 at ground level predicts in cabin PaO2 of 50 and 55 respectively ( making correction for FiO 2, assuming constant A-a gradient PaO2 at sea level alone as a predictor may misclassify many patients as A-a gradient and PaO2/ FiO2 ratios do not remain same at altitudes. Chi-Lem G. Arch. Med Res 1998;29:57-62
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Regression estimates of PaO 2 20.38- (3xaltitude) + 0.67x PaO 2 Ground (mmHg) Henry J. Surg Gynecol Obstet 1973;136:49-53 22.8 – (2.74 x Altitude) + 0.68 x PaO 2 Ground (mmHg) Not dependant on spirometric values moderate COPD (FEV1 40%) Gong H. Am Rev Respir Dis 1984; 130:980-986 Eq 1: 0.410 x PaO 2 Ground (mmHg) + 17.652 Eq 2: 0.519 x PaO 2 Ground (mmHg) + 11.855 x FEV1 (liters) – 1.760 Eq 3: 0.453 x PaO 2 Ground (mmHg) + 0.386 x (FEV1% pred) +2.44 Moderate COPD (FEV1 33%) Addition of spirometric values improve prediction Dillard TA. Ann Int Med1989;111:362-367
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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Air travel - Air travel : Implications for patients with...

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