Traveling with oxygen aboard commercial air carriers
- James K Stoller, MD, MS
James K Stoller, MD, MS
- Section Editor — Chronic Obstructive Pulmonary Disease
- Jean Wall Bennett Professor of Medicine, Samson Global Leadership Academy Endowed Chair
- Cleveland Clinic Lerner College of Medicine
- Chairman, Education Institute, Cleveland Clinic
It is estimated that over 2.7 billion passengers travel by air each year . Flying at a high altitude can induce significant hypoxemia in patients with underlying lung disease, despite pressurization of airliner cabins. A large number of air travelers have underlying medical conditions, including pulmonary disease, and are at risk for adverse cardiopulmonary effects related to oxygen desaturation [2-5].
The evaluation of patients for potential in-flight hypoxemia and the prescription of supplemental oxygen for air travel are reviewed here. General assessment and counseling prior to air travel and the indications for and provision of long-term supplemental oxygen are discussed separately. (See "Assessment of adult patients for air travel" and "Long-term supplemental oxygen therapy".)
EFFECTS OF AIR TRAVEL
Medical events occur during air travel in approximately 1 of every 604 flights with close to 44,000 in-flight medical emergencies occurring per year . Changes in atmospheric pressure and oxygen tension may contribute to these events.
Physiology — As altitude increases, ambient air pressure decreases, leading to a decrease in the oxygen tension (also known as the partial pressure of oxygen) of inspired air. The inspired oxygen tension (PiO2) can be determined by the equation:
PiO2 = FiO2 x (Patm - PH2O)
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- EFFECTS OF AIR TRAVEL
- SCREENING FOR IN-FLIGHT HYPOXEMIA
- Initial assessment with pulse oximetry
- Indications for further evaluation
- Methods for predicting in-flight hypoxemia
- - Regression equations
- - Hypoxia altitude simulation test
- - Hypobaric chamber
- Comparing methods
- DISEASE-SPECIFIC CONSIDERATIONS
- Cystic fibrosis
- Pulmonary hypertension
- Pulmonary lymphangioleiomyomatosis
- DETERMINING THE OXYGEN REQUIREMENT
- PRACTICAL CONSIDERATIONS
- TRAVELER RESOURCES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS