1. Assessing fitness to fly involves considering how the low pressure cabin environment may impact medical conditions. The reduced oxygen and dry air can affect the lungs and cardiovascular system.
2. For many stable cardiac and respiratory conditions, air travel is safe if supplemental oxygen is provided if needed. However, recent surgery, infections, or pneumothorax absolutely contraindicate air travel.
3. Diabetes and most stable hematological disorders usually do not restrict air travel if medications are properly managed for changing time zones. Pregnancy after 36 weeks or complications generally preclude air travel for safety.
This document reviews the evidence for and clinical use of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) during one-lung ventilation (OLV) for thoracic surgery. There are two main rationales for their use - to prevent hypoxemia and acute lung injury (ALI). Hypoxemia is common during OLV, and PEEP/CPAP help optimize oxygenation. Mechanical ventilation with high tidal volumes or pressures can cause ALI; PEEP/CPAP are part of a protective lung ventilation strategy to reduce mechanical stress and the risk of ALI when using low tidal volumes during OLV. The document outlines algorithms for applying PEEP/CP
The document discusses the case of a 27-year-old postpartum woman presenting with worsening dyspnea and hypoxia. It then reviews the key considerations and management strategies for acute respiratory distress syndrome (ARDS), including low tidal volume ventilation, open lung strategies using recruitment maneuvers and high positive end-expiratory pressure, unconventional approaches like airway pressure release ventilation and high frequency oscillatory ventilation, and adjunctive therapies such as prone positioning. The optimal ventilator mode, settings, and adjunctive strategies depend on the individual patient's severity of lung injury and response to different interventions.
Dr. Melaku Y. will present on acute respiratory distress syndrome (ARDS) and be moderated by Dr. Endashaw and Dr. Dejene. ARDS is a clinical syndrome characterized by rapid onset of severe breathing difficulties, low oxygen levels, and diffuse lung infiltrates leading to respiratory failure. It has multiple underlying causes and stages of severity. Treatment focuses on managing the underlying condition, limiting lung injury from mechanical ventilation, and maintaining optimal fluid levels.
1) Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition caused by injury to the lungs. It can result from direct lung injury, such as pneumonia, or indirect injury, like sepsis.
2) ARDS progresses through exudative and proliferative phases characterized by fluid accumulation and scarring in the lungs. This impairs gas exchange and causes respiratory failure.
3) Mechanical ventilation is used to treat respiratory failure but can further damage the lungs if not done carefully. The ARDSNet trial showed using low tidal volumes of 6 ml/kg improved survival compared to larger volumes.
A presentation by Jon Henrik Laake at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
This document discusses respiratory mechanics and ventilator waveforms in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). It begins by explaining that ARDS is traditionally viewed as a syndrome of low lung compliance, but modern tools have revealed more complex regional mechanics. Computed tomography imaging shows consolidated and aerated lung regions can coexist. While average compliance is low, individual lung areas may differ. The document then reviews time-related changes in recruitment and how maneuvers like prone positioning and higher pressures can influence recruitment. It emphasizes that ventilator waveforms now allow bedside monitoring of compliance, resistance, and pressures to guide individualized ventilation in critically ill patients.
ARDS is defined by acute onset hypoxemia caused by bilateral lung infiltrates from non-cardiogenic pulmonary edema. The Berlin definition categorizes ARDS as mild, moderate, or severe based on oxygenation levels. Mechanical ventilation can worsen lung injury so strategies aim to limit tidal volumes and pressures while using PEEP to recruit alveoli. Additional techniques like prone positioning, inhaled nitric oxide, and alternative modes may help in severe cases but require more study.
What's new in critical care of the burn injured patientanestesiahsb
This document summarizes recent advances in critical care management that have contributed to declining mortality in burn patients. It discusses low-tidal volume ventilation, which reduces ventilator-induced lung injury. It also discusses fluid resuscitation guidelines and efforts to define optimal endpoints. New ventilation strategies like airway pressure release ventilation and high-frequency oscillatory ventilation are presented, though more research is needed on their effectiveness for burns. Overall advances in ventilation management and fluid resuscitation have improved survival for burn patients.
This document reviews the evidence for and clinical use of continuous positive airway pressure (CPAP) and positive end-expiratory pressure (PEEP) during one-lung ventilation (OLV) for thoracic surgery. There are two main rationales for their use - to prevent hypoxemia and acute lung injury (ALI). Hypoxemia is common during OLV, and PEEP/CPAP help optimize oxygenation. Mechanical ventilation with high tidal volumes or pressures can cause ALI; PEEP/CPAP are part of a protective lung ventilation strategy to reduce mechanical stress and the risk of ALI when using low tidal volumes during OLV. The document outlines algorithms for applying PEEP/CP
The document discusses the case of a 27-year-old postpartum woman presenting with worsening dyspnea and hypoxia. It then reviews the key considerations and management strategies for acute respiratory distress syndrome (ARDS), including low tidal volume ventilation, open lung strategies using recruitment maneuvers and high positive end-expiratory pressure, unconventional approaches like airway pressure release ventilation and high frequency oscillatory ventilation, and adjunctive therapies such as prone positioning. The optimal ventilator mode, settings, and adjunctive strategies depend on the individual patient's severity of lung injury and response to different interventions.
Dr. Melaku Y. will present on acute respiratory distress syndrome (ARDS) and be moderated by Dr. Endashaw and Dr. Dejene. ARDS is a clinical syndrome characterized by rapid onset of severe breathing difficulties, low oxygen levels, and diffuse lung infiltrates leading to respiratory failure. It has multiple underlying causes and stages of severity. Treatment focuses on managing the underlying condition, limiting lung injury from mechanical ventilation, and maintaining optimal fluid levels.
1) Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition caused by injury to the lungs. It can result from direct lung injury, such as pneumonia, or indirect injury, like sepsis.
2) ARDS progresses through exudative and proliferative phases characterized by fluid accumulation and scarring in the lungs. This impairs gas exchange and causes respiratory failure.
3) Mechanical ventilation is used to treat respiratory failure but can further damage the lungs if not done carefully. The ARDSNet trial showed using low tidal volumes of 6 ml/kg improved survival compared to larger volumes.
A presentation by Jon Henrik Laake at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
This document discusses respiratory mechanics and ventilator waveforms in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). It begins by explaining that ARDS is traditionally viewed as a syndrome of low lung compliance, but modern tools have revealed more complex regional mechanics. Computed tomography imaging shows consolidated and aerated lung regions can coexist. While average compliance is low, individual lung areas may differ. The document then reviews time-related changes in recruitment and how maneuvers like prone positioning and higher pressures can influence recruitment. It emphasizes that ventilator waveforms now allow bedside monitoring of compliance, resistance, and pressures to guide individualized ventilation in critically ill patients.
ARDS is defined by acute onset hypoxemia caused by bilateral lung infiltrates from non-cardiogenic pulmonary edema. The Berlin definition categorizes ARDS as mild, moderate, or severe based on oxygenation levels. Mechanical ventilation can worsen lung injury so strategies aim to limit tidal volumes and pressures while using PEEP to recruit alveoli. Additional techniques like prone positioning, inhaled nitric oxide, and alternative modes may help in severe cases but require more study.
What's new in critical care of the burn injured patientanestesiahsb
This document summarizes recent advances in critical care management that have contributed to declining mortality in burn patients. It discusses low-tidal volume ventilation, which reduces ventilator-induced lung injury. It also discusses fluid resuscitation guidelines and efforts to define optimal endpoints. New ventilation strategies like airway pressure release ventilation and high-frequency oscillatory ventilation are presented, though more research is needed on their effectiveness for burns. Overall advances in ventilation management and fluid resuscitation have improved survival for burn patients.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are considered part of the same spectrum of disease. ARDS was first described in 1967 and involves acute respiratory failure from pulmonary edema without heart failure. In 1994, diagnostic criteria were established for ALI and ARDS based on severity. A landmark 2000 study found that using low tidal volume ventilation (6-8 mL/kg) compared to conventional volumes (10-12 mL/kg) reduced mortality in ARDS patients by 22%. Low tidal volumes are now the standard of care for reducing mortality and improving outcomes in ARDS.
This document summarizes recent research on ventilator management strategies for ARDS. It finds that low tidal volume ventilation (6 ml/kg) reduces mortality compared to higher volumes. Maintaining low plateau pressures (<30 cmH2O) is also associated with better outcomes. Lung recruitment maneuvers may be beneficial, especially early in ARDS, but more research is still needed. The optimal methods for setting PEEP levels and whether alternative modes like HFO are superior also remain unclear areas requiring further study. Prone positioning improves oxygenation but its effect on mortality has yet to be definitively determined.
The document summarizes information about acute respiratory distress syndrome (ARDS). It defines ARDS and provides diagnostic criteria. It discusses the pathophysiology and progression of ARDS. It outlines ventilation strategies for ARDS including low tidal volumes, limiting plateau pressures, use of PEEP, recruitment maneuvers, prone positioning, and extracorporeal membrane oxygenation. It also discusses pharmacologic interventions like steroids and fluid management considerations for ARDS patients.
This document discusses protective lung ventilation strategies during and after cardiac surgery to reduce postoperative pulmonary complications (PPCs). It notes that as many as 20% of patients undergoing cardiac surgery develop acute respiratory distress syndrome (ARDS), which has a high mortality rate. Protective ventilation strategies using lower tidal volumes, positive end-expiratory pressure (PEEP), and recruitment maneuvers have been shown in randomized controlled trials to reduce inflammatory markers and incidence of PPCs compared to conventional ventilation with higher tidal volumes and no PEEP. The IMPROVE trial also found protective ventilation during abdominal surgery reduced postoperative pulmonary and extrapulmonary complications and length of ICU stay compared to non-protective ventilation.
A study that has been conducted to assess incidence and risk factors of postintubation cardiovascular collapse and its impact on ICU length of stay and ICU mortality
This document provides an overview of pediatric acute respiratory distress syndrome (ARDS) including its history, definitions, epidemiology, pathophysiology, diagnosis, and treatment options. It reviews the key findings and recommendations from major clinical trials regarding ventilator strategies like lung protective ventilation with low tidal volumes, permissive hypercapnia, levels of positive end-expiratory pressure, and prone positioning. While adult studies have established low tidal volume ventilation as the standard of care, large pediatric trials are still needed due to the challenges of enrolling sufficient patient numbers required to detect differences in mortality.
The document defines acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) according to criteria from a 1994 consensus conference. It discusses the epidemiology and clinical disorders associated with ALI/ARDS development. Ventilator-based strategies for management include using low tidal volumes (6 ml/kg) and positive end-expiratory pressure (PEEP) of 13-16 cm H2O to reduce ventilator-induced lung injury from overdistension and repetitive opening/closing of alveoli. Recruitment maneuvers involving brief increases in pressure have been used to improve oxygenation by opening collapsed lung regions.
This document provides an overview of the diagnosis and management of Acute Respiratory Distress Syndrome (ARDS). It begins with defining ARDS and discussing the Berlin definition. It then covers risk factors, etiology, clinical course, pathophysiology, differential diagnosis, and management approaches. The management section emphasizes the importance of lung-protective ventilation with low tidal volumes to prevent ventilator-induced lung injury in ARDS patients.
This document discusses ventilator induced lung injury (VILI) from barotrauma to biotrauma. It explores how injurious ventilator strategies can increase cytokines and lead to inflammation in isolated rat lung models. High pulmonary vascular flow and pulmonary capillary pressure were shown to promote lung damage, edema, and hemorrhage independent of ventilator settings. A study on isolated perfused rabbit lungs found that high pulmonary vascular flow and low positive end-expiratory pressure (PEEP) led to increased lung weight gain and hemorrhage scores compared to low flow and high PEEP settings, particularly in a two-hit lung injury model using oleic acid pre-injury.
Recruitment Maneuvers in ARDS Dr Chennamchetty Vijay KumarVizae Kumar Chennam
This document discusses recruitment maneuvers for mechanically ventilated patients. It begins with a case study of a patient presenting with respiratory failure. It then provides definitions and the physiological rationale for recruitment maneuvers, including how alveolar collapse occurs in ARDS. Different types of recruitment maneuvers are described, as well as factors that influence their effectiveness. Clinical trials on recruitment maneuvers are summarized, which found no significant reduction in mortality but some improvement in secondary outcomes. Limitations of recruitment maneuvers are discussed, such as potential hemodynamic effects. The document concludes with emphasizing the complexity of lung recruitment and ongoing controversies regarding recruitment maneuvers.
This document discusses acute respiratory distress syndrome (ARDS). It defines ARDS as diffuse inflammatory lung injury leading to impaired gas exchange. ARDS is not a primary disorder but occurs due to infectious or non-infectious conditions like pneumonia or sepsis. Treatment involves treating the underlying cause, mechanical ventilation with a protective strategy using low tidal volumes and high PEEP, fluid management to avoid positive balance, and possibly steroids in moderate to severe cases. Outcomes are improved by following evidence-based guidelines for ARDS therapies.
Lung protective strategies in anaesthesiadrsoliman
This document discusses ventilator-induced lung injury during general anesthesia. It notes that mechanical ventilation can damage the lungs through overinflation, repetitive opening and closing of alveoli, and other mechanisms. This can lead to lung inflammation and injury referred to as ventilator-induced lung injury (VILI). The document recommends protective ventilatory strategies with low tidal volumes, moderate pressures, and positive end-expiratory pressure to prevent VILI during surgery and anesthesia. It also discusses atelectasis and aspiration as risks during anesthesia and their prevention.
The disease epidemiology covered in the report provides historical as well as forecasted ARDS epidemiology scenario in the 7MM covering the United States, EU5 countries (Germany, Spain, Italy, France, and the United Kingdom), and Japan from 2017 to 2030.
Stress & Strain during Lung Protective Ventilation Egypt Pulmonary Critical...Dr.Mahmoud Abbas
Stress & Strain During Lung Protective Ventilation. Presentation of Dr Lluis Blanch at Pulmonary Critical Care Egypt 2014 , the leading educational event and exhibition for Critical Care Medicine in Egypt. www.pccmegypt.com
This document discusses various topics related to ARDS including definitions, causes, ventilator strategies, and treatments. It provides the American-European Consensus definition of ARDS which requires bilateral infiltrates, hypoxemia, and no evidence of cardiogenic pulmonary edema. Common causes of ARDS are also mentioned. Regarding ventilator management, low tidal volumes, appropriate PEEP levels based on oxygen needs, and maintaining low plateau pressures are emphasized. Additional strategies discussed include prone positioning, recruitment maneuvers, and neuromuscular blockade. While high frequency oscillatory ventilation and inhaled treatments were investigated, they did not show clear benefits.
1. Several imaging modalities can provide detailed assessment of lung structure and function in asthmatic patients, including CT, MRI, PET, OCT, and EBUS.
2. Measurements from CT such as airway wall thickness, air trapping, and ventilation defects have been shown to correlate with disease severity and control.
3. Imaging measurements can serve as biomarkers to evaluate responses to new therapies like inhaled corticosteroids and anti-IL5 monoclonal antibodies, and determine if treatments are modifying the disease course.
This document provides an overview of acute respiratory distress syndrome (ARDS). It defines ARDS and discusses its causes, pathophysiology, diagnosis, incidence, prognosis and long-term outcomes. Treatment focuses on supportive care including mechanical ventilation with low tidal volumes, conservative fluid management, prone positioning and other strategies to improve oxygenation. Corticosteroids are not recommended for treatment due to lack of proven benefit. With treatment, prognosis depends on the underlying cause, but many ARDS survivors can expect to return to normal lifestyles within a year.
This document discusses various ventilatory strategies for treating ALI/ARDS, including:
- Using low tidal volumes (6 ml/kg) instead of conventional volumes to decrease mortality.
- Using PEEP to recruit collapsed lung units and prevent atelectrauma.
- Pressure-controlled ventilation to limit peak pressures while maintaining oxygenation.
- Permissive hypercapnia to decrease lung injury even if it increases CO2 levels.
- Prone positioning and recruitment maneuvers to improve oxygenation by opening collapsed alveoli.
- High frequency ventilation and airway pressure release ventilation as rescue therapies.
This document discusses pulmonary recruitment in ARDS patients and strategies for lung protection during mechanical ventilation. It describes how recruitment maneuvers using high airway pressures can reopen collapsed alveoli, preventing ventilator-induced lung injury from repeated opening and closing. The optimal settings for recruitment maneuvers and PEEP levels depend on a patient's recruitability, assessed via low-flow pressure-volume curves. PEEP levels are best guided by esophageal manometry or oxygen saturation to maintain alveolar stability and oxygenation without overdistension.
Respiratory diseases are leading causes of death worldwide. Patients with chronic lung diseases are at risk of hypoxemia during air travel due to lower oxygen levels at high altitudes. The document provides guidance on evaluating fitness to fly for various respiratory conditions through tests such as pulse oximetry, hypoxemia prediction equations, 6-minute walk tests, and hypoxia altitude simulation tests. Conditions that generally contraindicate air travel include active pneumothorax, severe pulmonary hypertension, and uncontrolled asthma. Pre-travel evaluation is advised for patients with COPD, ILD, cystic fibrosis or other lung diseases.
- Respiratory diseases like COPD, asthma, pneumonia and tuberculosis are leading causes of death and disability worldwide, affecting millions of people.
- Air travel can negatively impact respiratory patients due to decreased oxygen levels at high altitudes. Patients with impaired lung function are at higher risk of hypoxemia.
- A clinical evaluation including tests like 6MWT, HAST, and oxygen prediction equations can assess a patient's risk and determine if supplemental oxygen is needed for air travel. Absolute contraindications include active pneumothorax and severe pulmonary hypertension.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are considered part of the same spectrum of disease. ARDS was first described in 1967 and involves acute respiratory failure from pulmonary edema without heart failure. In 1994, diagnostic criteria were established for ALI and ARDS based on severity. A landmark 2000 study found that using low tidal volume ventilation (6-8 mL/kg) compared to conventional volumes (10-12 mL/kg) reduced mortality in ARDS patients by 22%. Low tidal volumes are now the standard of care for reducing mortality and improving outcomes in ARDS.
This document summarizes recent research on ventilator management strategies for ARDS. It finds that low tidal volume ventilation (6 ml/kg) reduces mortality compared to higher volumes. Maintaining low plateau pressures (<30 cmH2O) is also associated with better outcomes. Lung recruitment maneuvers may be beneficial, especially early in ARDS, but more research is still needed. The optimal methods for setting PEEP levels and whether alternative modes like HFO are superior also remain unclear areas requiring further study. Prone positioning improves oxygenation but its effect on mortality has yet to be definitively determined.
The document summarizes information about acute respiratory distress syndrome (ARDS). It defines ARDS and provides diagnostic criteria. It discusses the pathophysiology and progression of ARDS. It outlines ventilation strategies for ARDS including low tidal volumes, limiting plateau pressures, use of PEEP, recruitment maneuvers, prone positioning, and extracorporeal membrane oxygenation. It also discusses pharmacologic interventions like steroids and fluid management considerations for ARDS patients.
This document discusses protective lung ventilation strategies during and after cardiac surgery to reduce postoperative pulmonary complications (PPCs). It notes that as many as 20% of patients undergoing cardiac surgery develop acute respiratory distress syndrome (ARDS), which has a high mortality rate. Protective ventilation strategies using lower tidal volumes, positive end-expiratory pressure (PEEP), and recruitment maneuvers have been shown in randomized controlled trials to reduce inflammatory markers and incidence of PPCs compared to conventional ventilation with higher tidal volumes and no PEEP. The IMPROVE trial also found protective ventilation during abdominal surgery reduced postoperative pulmonary and extrapulmonary complications and length of ICU stay compared to non-protective ventilation.
A study that has been conducted to assess incidence and risk factors of postintubation cardiovascular collapse and its impact on ICU length of stay and ICU mortality
This document provides an overview of pediatric acute respiratory distress syndrome (ARDS) including its history, definitions, epidemiology, pathophysiology, diagnosis, and treatment options. It reviews the key findings and recommendations from major clinical trials regarding ventilator strategies like lung protective ventilation with low tidal volumes, permissive hypercapnia, levels of positive end-expiratory pressure, and prone positioning. While adult studies have established low tidal volume ventilation as the standard of care, large pediatric trials are still needed due to the challenges of enrolling sufficient patient numbers required to detect differences in mortality.
The document defines acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) according to criteria from a 1994 consensus conference. It discusses the epidemiology and clinical disorders associated with ALI/ARDS development. Ventilator-based strategies for management include using low tidal volumes (6 ml/kg) and positive end-expiratory pressure (PEEP) of 13-16 cm H2O to reduce ventilator-induced lung injury from overdistension and repetitive opening/closing of alveoli. Recruitment maneuvers involving brief increases in pressure have been used to improve oxygenation by opening collapsed lung regions.
This document provides an overview of the diagnosis and management of Acute Respiratory Distress Syndrome (ARDS). It begins with defining ARDS and discussing the Berlin definition. It then covers risk factors, etiology, clinical course, pathophysiology, differential diagnosis, and management approaches. The management section emphasizes the importance of lung-protective ventilation with low tidal volumes to prevent ventilator-induced lung injury in ARDS patients.
This document discusses ventilator induced lung injury (VILI) from barotrauma to biotrauma. It explores how injurious ventilator strategies can increase cytokines and lead to inflammation in isolated rat lung models. High pulmonary vascular flow and pulmonary capillary pressure were shown to promote lung damage, edema, and hemorrhage independent of ventilator settings. A study on isolated perfused rabbit lungs found that high pulmonary vascular flow and low positive end-expiratory pressure (PEEP) led to increased lung weight gain and hemorrhage scores compared to low flow and high PEEP settings, particularly in a two-hit lung injury model using oleic acid pre-injury.
Recruitment Maneuvers in ARDS Dr Chennamchetty Vijay KumarVizae Kumar Chennam
This document discusses recruitment maneuvers for mechanically ventilated patients. It begins with a case study of a patient presenting with respiratory failure. It then provides definitions and the physiological rationale for recruitment maneuvers, including how alveolar collapse occurs in ARDS. Different types of recruitment maneuvers are described, as well as factors that influence their effectiveness. Clinical trials on recruitment maneuvers are summarized, which found no significant reduction in mortality but some improvement in secondary outcomes. Limitations of recruitment maneuvers are discussed, such as potential hemodynamic effects. The document concludes with emphasizing the complexity of lung recruitment and ongoing controversies regarding recruitment maneuvers.
This document discusses acute respiratory distress syndrome (ARDS). It defines ARDS as diffuse inflammatory lung injury leading to impaired gas exchange. ARDS is not a primary disorder but occurs due to infectious or non-infectious conditions like pneumonia or sepsis. Treatment involves treating the underlying cause, mechanical ventilation with a protective strategy using low tidal volumes and high PEEP, fluid management to avoid positive balance, and possibly steroids in moderate to severe cases. Outcomes are improved by following evidence-based guidelines for ARDS therapies.
Lung protective strategies in anaesthesiadrsoliman
This document discusses ventilator-induced lung injury during general anesthesia. It notes that mechanical ventilation can damage the lungs through overinflation, repetitive opening and closing of alveoli, and other mechanisms. This can lead to lung inflammation and injury referred to as ventilator-induced lung injury (VILI). The document recommends protective ventilatory strategies with low tidal volumes, moderate pressures, and positive end-expiratory pressure to prevent VILI during surgery and anesthesia. It also discusses atelectasis and aspiration as risks during anesthesia and their prevention.
The disease epidemiology covered in the report provides historical as well as forecasted ARDS epidemiology scenario in the 7MM covering the United States, EU5 countries (Germany, Spain, Italy, France, and the United Kingdom), and Japan from 2017 to 2030.
Stress & Strain during Lung Protective Ventilation Egypt Pulmonary Critical...Dr.Mahmoud Abbas
Stress & Strain During Lung Protective Ventilation. Presentation of Dr Lluis Blanch at Pulmonary Critical Care Egypt 2014 , the leading educational event and exhibition for Critical Care Medicine in Egypt. www.pccmegypt.com
This document discusses various topics related to ARDS including definitions, causes, ventilator strategies, and treatments. It provides the American-European Consensus definition of ARDS which requires bilateral infiltrates, hypoxemia, and no evidence of cardiogenic pulmonary edema. Common causes of ARDS are also mentioned. Regarding ventilator management, low tidal volumes, appropriate PEEP levels based on oxygen needs, and maintaining low plateau pressures are emphasized. Additional strategies discussed include prone positioning, recruitment maneuvers, and neuromuscular blockade. While high frequency oscillatory ventilation and inhaled treatments were investigated, they did not show clear benefits.
1. Several imaging modalities can provide detailed assessment of lung structure and function in asthmatic patients, including CT, MRI, PET, OCT, and EBUS.
2. Measurements from CT such as airway wall thickness, air trapping, and ventilation defects have been shown to correlate with disease severity and control.
3. Imaging measurements can serve as biomarkers to evaluate responses to new therapies like inhaled corticosteroids and anti-IL5 monoclonal antibodies, and determine if treatments are modifying the disease course.
This document provides an overview of acute respiratory distress syndrome (ARDS). It defines ARDS and discusses its causes, pathophysiology, diagnosis, incidence, prognosis and long-term outcomes. Treatment focuses on supportive care including mechanical ventilation with low tidal volumes, conservative fluid management, prone positioning and other strategies to improve oxygenation. Corticosteroids are not recommended for treatment due to lack of proven benefit. With treatment, prognosis depends on the underlying cause, but many ARDS survivors can expect to return to normal lifestyles within a year.
This document discusses various ventilatory strategies for treating ALI/ARDS, including:
- Using low tidal volumes (6 ml/kg) instead of conventional volumes to decrease mortality.
- Using PEEP to recruit collapsed lung units and prevent atelectrauma.
- Pressure-controlled ventilation to limit peak pressures while maintaining oxygenation.
- Permissive hypercapnia to decrease lung injury even if it increases CO2 levels.
- Prone positioning and recruitment maneuvers to improve oxygenation by opening collapsed alveoli.
- High frequency ventilation and airway pressure release ventilation as rescue therapies.
This document discusses pulmonary recruitment in ARDS patients and strategies for lung protection during mechanical ventilation. It describes how recruitment maneuvers using high airway pressures can reopen collapsed alveoli, preventing ventilator-induced lung injury from repeated opening and closing. The optimal settings for recruitment maneuvers and PEEP levels depend on a patient's recruitability, assessed via low-flow pressure-volume curves. PEEP levels are best guided by esophageal manometry or oxygen saturation to maintain alveolar stability and oxygenation without overdistension.
Respiratory diseases are leading causes of death worldwide. Patients with chronic lung diseases are at risk of hypoxemia during air travel due to lower oxygen levels at high altitudes. The document provides guidance on evaluating fitness to fly for various respiratory conditions through tests such as pulse oximetry, hypoxemia prediction equations, 6-minute walk tests, and hypoxia altitude simulation tests. Conditions that generally contraindicate air travel include active pneumothorax, severe pulmonary hypertension, and uncontrolled asthma. Pre-travel evaluation is advised for patients with COPD, ILD, cystic fibrosis or other lung diseases.
- Respiratory diseases like COPD, asthma, pneumonia and tuberculosis are leading causes of death and disability worldwide, affecting millions of people.
- Air travel can negatively impact respiratory patients due to decreased oxygen levels at high altitudes. Patients with impaired lung function are at higher risk of hypoxemia.
- A clinical evaluation including tests like 6MWT, HAST, and oxygen prediction equations can assess a patient's risk and determine if supplemental oxygen is needed for air travel. Absolute contraindications include active pneumothorax and severe pulmonary hypertension.
This document summarizes a presentation on Acute Respiratory Distress Syndrome (ARDS). It discusses the history, epidemiology, causes, pathogenesis, clinical features, investigations and management of ARDS. The key points are: ARDS is caused by diffuse lung inflammation from various diseases and injuries and results in hypoxemia resistant to oxygen therapy. It has been recognized since World War I. The incidence is 13.5-78.9 cases per 100,000 people. Common causes include asthma, pneumonia, burns and pancreatitis. Pathogenesis involves neutrophils, macrophages and inflammatory mediators damaging the lungs. Clinical features range from hyperventilation to respiratory failure and multi-organ dysfunction. Diagnosis is based on hypoxemia,
The document summarizes acute respiratory distress syndrome (ARDS), including its definition, risk factors, pathophysiology, clinical presentation, management, and treatment. ARDS is characterized by hypoxemia, bilateral lung infiltrates, and respiratory failure caused by various lung injuries. It involves exudative, proliferative and fibrotic phases. Management includes mechanical ventilation with low tidal volumes, positive end-expiratory pressure, fluid restriction and treatment of underlying conditions. However, mortality remains high at 50-60%.
World Laparoscopy Hospital provides learning by doing. It provides real-world laparoscopic surgery experience by allowing the trainee to get hands-on directly with whatever surgeons are learning and developing a sense of empowerment. After taking this laparoscopic training course, surgeons and gynecologists can perform laparoscopic surgery them self on their patients with confidence.
The anesthetic problems during minimal access surgery
are related to the cardiopulmonary effects of pneumoperitoneum, carbon dioxide (CO2) absorption, extraperitoneal
gas insufflation, venous embolism, and inadvertent injuries
to intraabdominal organs. Optimal anesthetic care of
patients undergoing laparoscopic surgery is very much
important. Good anesthetic techniques facilitate riskfree surgery and allow early detection and reduction of
complications.
In young patients, fit for diagnostic laparoscopy, general
anesthesia is the preferred method and does not impose
any increased risk. Adequate anesthesia and analgesia
are essential and endotracheal intubation and controlled
ventilation should be considered. The pneumoperitoneum
can be created safely under local anesthesia provided that
the patient is adequately sedated throughout the procedure.
For successful laparoscopy under local anesthesia, intravenous (IV) medication for sedation should be given
The anesthetic problems during minimal access surgery are related to the cardiopulmonary effects of pneumoperitoneum, carbon dioxide (CO2) absorption, extraperitoneal
gas insufflation, venous embolism, and inadvertent injuries to intraabdominal organs.
This document discusses thoracic anesthesia and includes outlines of topics, objectives, and details on preoperative evaluation, preparation, intraoperative monitoring, physiology of the lateral decubitus position under different conditions, and management of one-lung ventilation. Specifically, it covers assessing the surgical patient, optimizing medical conditions preoperatively, important intraoperative monitors, how induction of anesthesia and opening the chest impact ventilation and perfusion in the lateral position, and goals of managing one-lung ventilation.
This document provides information about pediatric acute respiratory distress syndrome (PARDS). It defines PARDS as a complex inflammatory lung condition characterized by hypoxemia and respiratory failure. The pathogenesis involves endothelial injury, edema fluid exudation in the lungs, and impaired gas exchange. Clinically, PARDS presents with severe hypoxemia, increased work of breathing, and bilateral lung infiltrates. Treatment focuses on mechanical ventilation with low tidal volumes, moderate PEEP, and permissive hypoxemia/hypercapnia to minimize ventilator-induced lung injury while maintaining oxygenation and CO2 removal. Complications can include multi-organ system failure, infections, and long-term issues from prolonged ventilation.
The document discusses factors that can predict and cause hypoxemia during one-lung ventilation (OLV) for thoracic surgery. It notes that preoperative pulmonary function tests are not reliable predictors, but that oxygen levels during two-lung ventilation or with high oxygen are better predictors. The main cause of hypoxemia is inadequate hypoxic pulmonary vasoconstriction in the non-ventilated lung from issues like double lumen tube malposition or collapse. Strategies to prevent hypoxemia include high oxygen levels, continuous positive airway pressure to the non-ventilated lung, and re-inflating the lung if needed. Future techniques may involve modulating pulmonary blood flow pharmacologically.
Acute Respiratory Distress Syndrome (ARDS) is an acute lung injury syndrome characterized by hypoxemia, bilateral pulmonary infiltrates, and respiratory failure. It has a complex pathophysiology involving direct or indirect lung injury leading to increased permeability, protein-rich fluid accumulation in the lungs, and impaired gas exchange. ARDS progresses through exudative, proliferative, and fibrotic phases. Diagnosis is based on timing of onset, radiographic findings, and hypoxemia as defined by the Berlin criteria. Treatment involves supportive care, ventilator management to avoid further lung injury, and treating underlying causes.
This document provides information about pediatric acute respiratory distress syndrome (PARDS). It defines PARDS as a complex inflammatory lung condition characterized by hypoxemia and respiratory failure. The document discusses the clinical features, pathogenesis, respiratory support strategies, complications, and goals of ventilator management for PARDS patients, which aim to maintain adequate gas exchange while minimizing ventilator-induced lung injury. Target oxygen saturation is 88-95% to allow permissive hypoxemia and hypercapnia. Ventilation strategies emphasize low tidal volumes, appropriate positive end-expiratory pressure, and monitoring of ventilation parameters.
Medicine (respiratory) treatment guidelines Govt of IndiaDr Jitu Lal Meena
This document provides guidelines for the diagnosis and management of acute respiratory distress syndrome (ARDS) and bronchial asthma in India. It discusses the definition, causes, incidence, diagnosis, and treatment of ARDS and asthma. For ARDS, treatment involves supplemental oxygen, ventilatory support using lung protective strategies, fluid management, and management of the underlying cause. Treatment is more advanced in tertiary hospitals where technologies like computed tomography and extracorporeal membrane oxygenation are available. The document provides diagnostic and treatment protocols for secondary and tertiary hospitals.
Anesthesia For Patients Requiring Advanced Ventilatory Supportsxbenavides
This document discusses anesthesia considerations for patients requiring advanced ventilatory support. It begins with definitions of respiratory failure and hypoxia. It then reviews the physiology of mechanical ventilation, discussing mechanics, management of ventilation and oxygenation, and advanced modes available in intensive care units. It focuses on pressure-controlled ventilation as an important mode that can help maintain pressures below injury thresholds and improve oxygenation through higher mean airway pressures. The challenges of ventilating critically ill patients with lung damage and maintaining oxygenation within safe pressure limits are also addressed.
The document provides information about acute respiratory distress syndrome (ARDS). It begins with a brief history of ARDS and provides the clinical definition. It describes the diagnostic criteria and etiology, including that most cases are caused by sepsis, pneumonia, or trauma. It then discusses the normal lung physiology and pathophysiology of ARDS, which involves three phases: exudative, proliferative, and fibrotic. The management section outlines the principles of therapy to provide adequate gas exchange while avoiding secondary injury, including mechanical ventilation protocols, fluid management, and other strategies. It concludes with a discussion of prognosis and recent advances in ARDS management such as protective ventilation strategies.
Aviation medicine, also known as aerospace medicine, focuses on the health and safety of aircrews, passengers, and support staff. It addresses issues related to flying in various environments including hypoxic conditions at high altitudes. The presentation traces the history and development of the field from early experimentation to the establishment of regulatory bodies. It describes the roles and challenges of military, civilian and space operations. Key topics covered include hypoxia, barotrauma, acceleration forces, fatigue management and infectious disease control. The presentation concludes with an overview of the roles and activities of the Institute of Aerospace Medicine in Bangalore, India, which is a key center for aeromedical training and research.
Updates on Acute respiratory distress syndromeHamdi Turkey
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Assessing fitness to_fly
1. Assessing fitness to fly
Guidelines for medical professionals from the Aviation Health Unit,
UK Civil Aviation Authority
Introduction be taken into consideration for those Table 1
Every year, over one billion people with cardiac, pulmonary conditions
Cardiovascular indications for
travel by air and that figure is or anaemia.
medical oxygen during
predicted to double in the next two
commercial airline flights
decades. Air travel is a comfortable The decrease in ambient pressure in
and safe means of transport and is the cabin, compared to ground l Use of oxygen at baseline
accessible to all sectors of the level, will cause any gas to expand altitude
population. The global increase in and increase in volume by l CHF NYHA class III - IV or
travel, as well as an increasingly approximately 30%, which may baseline PaO2 less than 70 mm
aged population, means that there cause problems if trapped in any Hg
will be a significant increase in older body cavity, e.g. the ear, giving rise l Angina CCS class III-IV
passengers and those with illness to pain and possible perforation of l Cyanotic congenital heart
who will wish to travel. the ear drum. Similar issues may disease
occur following surgery, if gas is l Primary pulmonary
Physiology of flight introduced to the abdominal cavity hypertension
An understanding of the physics or the eye. l Other cardiovascular diseases
and physiology of flying and how associated with known baseline
this may interact with pathology is Contrary to what is believed by hypoxaemia
useful in coming to an objective many, the aircraft cabin
conclusion about a passenger’s environment does not result in CHF - Congestive Heart Failure
fitness to fly. Contrary to popular dehydration, as there is no evidence NYHA - New York Heart
belief, modern aircraft are not of any change in osmolality. Association
pressurised to sea level equivalent, However, the cabin has a low CCS - Canadian Cardiovascular
and fly with a cabin altitude humidity, usually in the range of Society
between 5,000 and 8,000 feet. This 10% to 20% compared to that in
results in reduced barometric buildings, which is in the order of
pressure and a concomitant 40% to 50%. This is particularly increasing their ventilation and by
decrease in the partial pressure of noticeable in the mucous developing a mild tachycardia,
alveolar oxygen (PaO2). Few aircraft membranes, especially if wearing which may result in increased
fly for any significant period of time contact lenses and also in the skin. myocardial oxygen demand. In
at the upper limit of cabin altitude of patients with limited cardiac reserve,
8,000 feet, where the barometric Jet lag, or circadian dysrhythmia, in the use of supplemental oxygen
pressure is approximately 565 mm addition to being an annoyance for (Table 1) may be required and most
Hg with an alveolar partial pressure healthy travellers may complicate commercial airlines will supply this
of O2 of approximately 75mm Hg. the timing of medication, e.g. in when requested in advance
However, due to the shape of the diabetic passengers who are treated although a charge may be levied.
oxy-haemoglobin dissociation curve with insulin (see below). There is currently ongoing work,
(Figure 1), this only results in a fall of with the Department for Transport,
oxygen saturation to around 90%. On commercial flights, regardless of looking at the carriage of oxygen.
This fall is well tolerated by most aircraft type, many passengers sit in This may permit passengers to carry
healthy travellers and is smaller spaces than in the home their own oxygen, but the results of
compensated by the normal environment and may have reduced this work are not yet complete.
physiological response. However, opportunity to get up and walk
this decrease in saturation needs to about. The potential for the Despite the physiological changes
development of travellers’ that occur at altitude, the majority of
thrombosis (see below), particularly patients with cardiac conditions can
on long haul flights, should be travel safely as long as they are
borne in mind and the use of lower cautioned to carry their medications
limb exercises may be of value in in their hand baggage.
improving the venous return.
Angina Pectoris, if stable, is usually
Cardiovascular disease not a problem in flight.
Hypobaric hypoxia, i.e. that due to a Patients with a recent myocardial
lowered oxygen pressure at altitude, infarction may travel after 7 to 10
is an area of concern for travellers days if there are no complications. If
with cardiovascular disease. The the patient has undergone an
decrease in oxygen saturation may exercise test which shows no
have implications for passengers residual ischaemia or symptoms,
with cardiac disease who wish to this may be helpful, but is not a
Figure 1: oxygen dissociation curve of travel. Patients compensate to an mandatory requirement.
whole blood extent for this relative hypoxia by
2. Coronary artery bypass grafting and medically stable. Interaction with environment does not represent a
other chest or thoracic surgery airline electronics or aviation specific challenge to those suffering
should prove no intrinsic risk in the security devices is highly unlikely for from asthma that is stable. The key
aviation environment as long as the the most common bi-polar issue is to ensure that all medication
patient has fully recovered without configuration. is carried in hand baggage. It may
complications. However, as air is Following a cerebrovascular be prudent that patients with
transiently introduced into the accident, patients are advised to asthma, other than the mildest
thoracic cavity, there is a potential wait 10 days following an event, cases, should take a course of oral
risk for barotrauma due to the although if stable, may be carried steroids with them, in order that
gaseous expansion which occurs at after 3 days. For those with cerebral they could intervene early if there is
altitude. It is therefore prudent that arterial insufficiency, supplementary any deterioration in their condition.
patients should wait until the air is oxygen may be advisable to prevent
reabsorbed, approximately 10 to 14 hypoxia. Chronic Obstructive Pulmonary
days before travelling by air. Disease (COPD)
Clinical judgement has an important Patients with chronic bronchitis and
Patients with uncomplicated role in the individual assessment of emphysema are susceptible to in-
percutaneous coronary fitness to fly. However, some flight hypoxaemia, depending on
interventions such as angioplasty cardiovascular contraindications to their baseline PaO2. The walking
with stent placement may be fit to flight are shown in Table 2. test and/or hypoxic challenge may
travel after 5 days, but should be be appropriate and medical oxygen
medically stable, and individual Respiratory disease can be provided by the airline with
assessment is essential. Medical advice to those with prior notification. A fee may be
respiratory disease on fitness to fly levied for this. Flow rates of 2 or 4
depends primarily on: litres per minute are usually
Table 2
available, but generally it is not
Cardiovascular
a) the type, reversibility and permissible for passengers to carry
contraindications to
functional severity of the underlying their own oxygen on board, as the
commercial airline flight
respiratory disease equipment must meet specific
aviation regulatory standards.
l Uncomplicated myocardial b) an assessment of the likely Particularly, there are issues
infarction within 7 days tolerance to the cabin altitude and concerning the permissible water
l Complicated myocardial ambient oxygen concentration. content to prevent freezing and the
infarction within 4-6 weeks type of valve, which must be able to
l Unstable angina In patients with significant disease, cope with varying cabin pressures.
l Decompensated congestive the relative hypoxia encountered in
heart failure the aircraft cabin may be easily Bronchiectasis and Cystic Fibrosis
l Coronary artery bypass graft correctable by therapeutic oxygen. Control of lung infection and
within 10 days The partial pressure of oxygen in measures designed to loosen and
l Cerebrovascular accident the cabin at normal cruising altitude clear secretions are important
within 3 days is considered to be equivalent to an aspects of medical care, both on the
l Uncontrolled cardiac oxygen concentration of ground and during travel.
arrhythmia approximately 17% at sea level. Appropriate antibiotic therapy,
l Severe symptomatic valvular Some respiratory physicians can adequate hydration and medical
heart disease carry out assessments in a oxygen may be required for both
laboratory using oxygen-nitrogen conditions. Medication to decrease
mixes to simulate this cabin sputum viscosity is helpful e.g.
environment. This is termed a deoxyribonuclease in the low
Symptomatic valvular heart disease ‘hypoxic challenge’. If it results in a humidity of the aircraft cabin.
is a relative contraindication to PaO2 less than 55 mm of mercury,
airline travel. Individual assessment medical oxygen is indicated. Respiratory infection
by the treating physician is essential, Patients with active or contagious
paying particular attention to the Guidelines on this approach to infection are unsuitable for travel
functional status, severity of assessment can be found at the until there is documented control of
symptoms and left ventricular British Thoracic Society website at the infection and they are no longer
function, in addition to the presence www.brit-thoracic.org.uk. infectious. Those recovering from
or absence of pulmonary acute bacterial infection e.g.
hypertension. There is no However, the single and most pneumonia should be clinically
contraindication to air travel for practical fitness to fly test, is to improved with no residual infection
patients with treated hypertension, assess whether the patient can walk and satisfactory exercise tolerance
as long as it is under satisfactory 50 yards/metres at a normal pace or before flying. Patients with
control and the patient is reminded climb one flight of stairs without respiratory viral infections e.g.
to carry their medication with them severe dyspnoea. If this can be influenza, may infect those sitting
on the flight. accomplished, it is likely that the adjacent to them and they should
patient will tolerate the normal postpone air travel until the infection
Those with pacemakers and aircraft environment. has resolved.
implantable cardioverter
defibrillators may travel without Asthma Pneumothorax
problems by air once they are The normal aircraft cabin The presence of a pneumothorax is
3. an absolute contraindication to air than they have been in the past. It is insulin is not packed in the hold
travel as trapped air may expand not uncommon to see young baggage even if it is not being used
and result in a tension patients with haemoglobins of the during the flight as insulin in the
pneumothorax. In general, it should order of 7 g/dl and elderly patients hold may be exposed to
be safe to travel approximately 2 with haemoglobins of temperatures that could degrade it
weeks after successful drainage of a approximately 8 g/dl (see and there is the potential risk of loss
pneumothorax with full expansion Haematological Disorders). of baggage en-route. Insulin may be
of the lung. If there is a need to satisfactorily carried in a cool bag for
travel earlier, safe travel is possible It is important to remember that even the longest sector. Individual
using a one-way Heimlich valve intestinal gas will expand by regimes should be discussed with
attached to the chest drain. approximately 30% by volume at a the diabetic management team, but
cabin altitude of 8,000 feet. Many some general guidelines may be
Pregnancy post-abdominal surgery patients helpful.
The advisability of flying whilst have a relative ileus for some days,
pregnant is a frequently asked thereby putting them at risk of When travelling east, the day will be
question. The commercial aircraft tearing suture lines, bleeding or shortened and if more than two
environment is not generally indeed, in extreme circumstances hours are lost, it may be necessary
considered hazardous to a normal perforation. Stretching intestinal or to take fewer units with intermediate
pregnancy. At a normal cabin gastric mucosa may also result in or long-acting insulin. When
altitude the maternal haemoglobin haemorrhage. To avoid such travelling west, the travel day will be
remains 90% saturated and because complications, travel should be extended and if this is more than 2
of the favourable properties of foetal avoided for 10 days following hours it may be necessary to
haemoglobin (HbF) including abdominal surgery. Following other supplement this with additional
increased oxygen carrying potential procedures, such as colonoscopy injections of short-acting insulin or
together with a high foetal where a large amount of gas has an increased dose of intermediate-
haematocrit and the Bohr effect, been introduced into the colon, it is acting insulin. Type 2 diabetes is not
foetal PaO2 changes very little. The advisable to avoid travel by air for a problem on diet or oral
key focus in assessment of fitness to 24 hours. Similarly, it is advisable to medication, nor indeed on insulin as
fly is the health and wellbeing of the avoid flying for approximately 24 the endogenous insulin, which
mother and the baby. Delivery in hours after laparoscopic remains in Type 2 diabetes will
flight, or diversion in flight to a intervention, due to the residual CO2 provide a suitable buffer and assist
location that may not have high gas, which may be in the intra- control. Further information on
quality obstetric services, is abdominal cavity. diabetes and travel is available from
undesirable. For this reason, most the Diabetes UK website
airlines do not allow travel after 36 Neurosurgical intervention may (www.diabetes.org.uk).
weeks for a single pregnancy and leave gas trapped within the skull,
after 32 weeks for a multiple which again may expand at altitude. Haematological disorders
pregnancy. Most airlines require a It is therefore advisable to avoid air Patients with a haemoglobin of
certificate after 28 weeks confirming travel for approximately 7 days greater than 8 g/dl may travel
that the pregnancy is progressing following this type of procedure. without problems assuming there is
normally, that there are no no coexisting condition such as
complications and the expected date Ophthalmological procedures for cardiovascular or respiratory
of delivery. In specific individual retinal detachment also involve the disease. If the haemoglobin is less
circumstances, an airline may allow introduction of gas by intra-ocular than 7.5 g/dl, special assessment
some discretion. injections, which temporarily should be made and the use of
increase intra-ocular pressure. supplemental oxygen should be
Surgical conditions Depending on the gas, it may be considered.
The issue of air travel following necessary to delay travel for
surgical intervention is becoming an approximately 2 weeks if sulphur Individuals with chronic renal
increasingly important issue with hexafluoride is used and for 6 weeks insufficiency or other medical
the wider use of day surgery. It with the use of perfluoropropane. condition predisposing to anaemia,
should be borne in mind that post- For other intra-ocular procedures which is chronic in nature, will
operative patients are in a state of and penetrating eye injuries, 1 week usually tolerate a lower
increased oxygen consumption due should elapse before flying. haemoglobin level than if the
to the trauma of surgery, the anaemia is of acute onset. Sickle cell
increased adrenergic outflow and Diabetes trait does not present a particular
the possible presence of sepsis. Air travel should not pose significant problem at normal cruising altitude.
Concurrently, oxygen levels may be problems for patients with well- However, patients with sickle cell
decreased or fixed in patients who controlled diabetes. Pre-planning is anaemia should travel with
are elderly, volume depleted, supplemental oxygen and should
important and discussion of the
anaemic or who have defer travel for approximately 10
itinerary with the diabetic
cardiopulmonary disease. days following a sickling crisis.
management team plays an
Consequently, for such patients it
important part in preparation for
would be wise to delay air travel for Trauma/orthopaedics
several days or request oxygen to travel. It is essential that the diabetic Following the application of a
be provided. With the decreased use passenger carries adequate plaster cast, the majority of airlines
of blood transfusion, many post- equipment and medication in their restrict flying for 24 hours on flights
operative patients are more anaemic hand baggage. It is important that of less than 2 hours or 48 hours for
4. longer flights. This is due to the fact “economy class syndrome”. There have medical advisors who provide
that air may be trapped beneath the is no evidence that the cabin advice and ’clear‘ passengers as fit
cast. If there is an urgent need for environment activates the to fly. The key information that they
travel before these limits, the plaster coagulation system of normal require is the nature of the
cast may be bi-valved. If a individuals. The absolute risk, as individual’s condition, its
pneumatic splint is used, some air shown in the WRIGHT Study, was 1 severity/stability, medication being
should be released to allow for in 4656 flights of more than 4 hours taken and any pertinent information
gaseous expansion at altitude, duration. The risk factors for about mobility. The clearance can be
which could cause discomfort as thrombosis are well known and are done by telephone or by formal
well as potential circulatory listed in Table 3. communication using the Med IF
compromise or neuropraxia. form available through travel agents
Prophylactic measures should be or from the Internet which allows
Psychiatric Conditions undertaken according to the degree the medical information to be
The key consideration in this area is of risk. Simple, effective measures structured in a manner that can be
identical to other medical are to move about the aircraft cabin processed by the majority of
conditions, i.e. will the condition and to carry out the lower limb airlines.
interfere with the safe conduct of the exercises shown in airline videos
flight? or will the flight environment and in-flight magazines. Any The final decision whether or not to
exacerbate the condition? With the specialised prophylaxis should be carry a passenger is that of the
modern management of many targeted at those at highest risk and airline, but the more information
psychiatric conditions, air travel include properly fitted anti- that is provided in advance, the
should not be a problem for the embolism stockings giving more likely it is that a fair, evidence-
majority of individuals. It is graduated compression to the limb, based decision can be made.
essential however, that the condition subcutaneous low molecular weight
is stable and if medication is heparin, which is highly effective Useful sources of
required it is taken regularly. The and has a low risk of bleeding and information
main areas for concern are those in extremely high risk cases, oral Aviation Health Unit
whose behaviour may be anticoagulation. It is important to www.caa.co.uk/aviationhealthunit
unpredictable, aggressive, emphasise that the risk of side
disorganised or disruptive. In these effects from the use of aspirin Aerospace Medical Association
circumstances, air travel would be outweigh any potential anti- www.asma.org/pdf/publications/m
contra-indicated. Patients with well- thrombotic effect and its use is not edguid.pdf
managed psychotic conditions may recommended.
require an escort to ensure regular British Airways
medication and to assist in case of www.britishairways.com/health/do
Table 3
problems. The escort may be a cs/before/airtravel_guide.pdf
Risk factors for DVT
reliable companion or in more
l Thrombophilia enhancing
difficult cases, a qualified health MEDIF Form
clotting activity
professional. Taking a careful history www.britishairways.com/cms/glob
eliciting especially details of l Recent major surgery al/assets/pdf/BA_Medif_123.pdf
previous disturbed or disorientated l Trauma or surgery of the
behaviour is particularly important. lower limbs British Medical Association
Close liaison with the treating l Family history of deep vein www.bma.org.uk/ap.nsf/Attachme
physician and the airline concerned thrombosis ntsByTitle/PDFFlying/$FILE/Impacto
is important and clearance to travel l Age > 40 years fflying.pdf
can be done by either telephone or l The oral contraceptive pill
by the formal Med IF form, details of Aviation Health Unit
which are given later in this
document. The UK Civil Aviation Authority’s
General issues Aviation Health Unit (AHU) was
DVT It is important to note that although formed on 1 December 2003 to
Deep vein thrombosis is not cabin crew are trained to render advise Government on
intrinsically dangerous but the advanced first aid, they are not passenger and aircrew health
complications of pulmonary trained to administer medication. In issues. In March 2007 the AHU
embolism can be life threatening. It addition, most airlines will assist was given an additional statutory
has been shown that DVT can occur passengers to reach the toilet function in safeguarding the
in many other forms of travel, as accommodation on the aircraft but health of all persons on board
described by Homans in 1954. The cannot render more personal aircraft. The recent House of
World Health Organisation Research hygiene or nursing care. Lords Inquiry (Air Travel and
Into Global Hazards of Travel
Health: an Update) emphasised
(WRIGHT) Project recently reported The majority of in-flight
the pivotal role of the Unit as a
that the key determinant for deep emergencies occur to individuals
focus for those interested in
venous thrombosis is whose medical condition is
immobilisation and the risk of unknown to the airline and it is aviation health matters. The AHU
thrombosis is increased by travel of therefore essential that the can be contacted on 01293
greater than 4 hours. Thus passenger’s physician sends 573674 or by email:
“travellers’ thrombosis” is the most adequate details well in advance of aviationhealthunit@caa.co.uk
appropriate term to use, rather than the flight to the carrier. Most airlines