Hypercapnic Respiratory Acidosis During An In-Flight Oxygen Assessment

Aerospace Medicine and Human Performance
Kristofer J SpurlingJoseph L Perks

Abstract

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 P(a)co(2) (5.64 kPa) and pH (7.36) with 98% S(p)O(2). HCT was performed delivering 15% FIo(2) via a mask, and the patient desaturated to < 85%. HCT blood gases revealed significant hypoxemia (P(a)o(2) < 6.6 kPa), indicating in-flight oxygen. Continuous oxygen at 2 L · min⁻¹ via nasal cannula corrected the hypoxia, although P(a)co(2) 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 ...Continue Reading

Citations

Oct 8, 2015·Ergonomics·Mariel GrassmannOmer Van den Bergh

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