OxygenTara Rose, RN

By SkyNurses.com

Agenda or Summary LayoutObjective: Pre-flight Evaluation Algorithm

Flight Physiology

SpO2 SL and SpO2 6MWT

Medical Clearance for the Use of POC

Types of Portable Oxygen Concentrators (POC)

Objective

Physiology

POC

Algorithm

MEDIF

Charting Patient Care Management

To construct a pre-flight evaluation algorithm for patients with COPD and respiratory insufficiency.

Objective

FLIGHT PHYSIOLOGYUnderstanding

Flight PhysiologyIntroductionTraveling by airplane exposes people to decreased air pressure and lower than normal oxygen levels. For most people, these changes are not noticeable. However, for a patient with certainly underlying lung conditions, small atmospheric changes can have significant and potentially severe effects.

Cabin Environment

Cabin PressureAlthough aircraft cabins are pressurized, that pressure (barometric pressure) is less than that on the ground. For most flights, the cabin pressure is the same as that at 5,000 – 8,000 feet above sea level. In other words, when you flying, the atmosphere within the aircraft is like that on the 5,000 – 8,000 feet peak of a small mountain.

Decrease of Barometric PressureThis has two effects:• There is less oxygen available because

the pressure of oxygen becomes lower.• Gas within our body cavities expands.

In a normal individual, this would cause arterial oxygen saturation to fall from 98% to 88%.

Decrease of Barometric Pressure Passengers may respond to this relatively hypoxic environment by increasing their:

• Heart Rate• Cardiac Output• Respiratory Rate and Volume

In individuals with cardiopulmonary disease, compensation can be insufficient.

Dalton’s LawThe total pressure of a gas mixture is the sum of the individual pressures or partial pressure of all gases in the mixture. In flight terms, oxygen is “thinner” in the upper atmosphere.

• Why is this? At sea level, the barometric pressure is 760mmHg, and the atmosphere is composed of 20.95% oxygen. As altitude increases, the barometric pressure decreases, and the molecules in the atmosphere move farther apart. While oxygen still comprises 20.95% of the atmosphere, there is less oxygen particles per cubic millimeter to be utilized.

SPO2 SL AND SPO2 6MWT

The Need for Oxygen

Patients with diseases that can cause low oxygen levels, particularly chronic obstructive pulmonary disease (COPD), may need oxygen supplementation in flight. This is true even if the person does not use oxygen at home.

The reduced pressure in the aircraft cabin may cause significant hypoxemia and respiratory distress in patients with COPD.

SpO2 SL and SpO2 6MWT

Oxygen

HAST

SpO2 6MWT

SpO2 SL

Evaluating Oxygen StatusMethod of Evaluation

• SpO2 SL• Sea level pulse oximetry at rest

• SpO2 6MWT (6 minute walk test)• Exercise desaturation

Sea Level – level with the ocean/sea.

SpO2 6MWT

SpO2 SL

Oxygen RequirementsPatients with diseases that can cause low oxygen levels, particularly COPD, may need oxygen supplementation in-flight. This is even true if the person does not use oxygen at home.

Not Suitable for Commercial Air TransportationSpO2 SL <90% on 2L/min or more Continuous Flow via NC

Oxygen 2 L/min Continuous Flow via NC SpO2 SL <92% but >90%

Oxygen 2-6 L/min pulse via NCSpO2 SL = 92-95% combined with SpO2 6MWT <84%

No Oxygen RequiredSpO2 SL >95% combined with SpO2 6MWT >84%

MEDICAL CLEARANCECommercial Airlines

Some medical conditions will require Sky Nurses to submit a medical information form to the airline before a patient is allowed to fly. Conditions that may require medical clearance are:

• Recent illness, hospitalization, injury or surgery

• Existing unstable medical condition

• Need for additional oxygen or use of medical equipment on board

• Traveling for medical reasons or treatment

MEDIFMedical Information Form

Completion of a MEDIFThe MEDIF will be completed by the In-House RN Coordinator. Upon completion, the MEDIF will be sent to the appropriate airline. The MEDIF will then be uploaded into the Travel Itinerary.

The MEDIF must accompany the clinician and patient during the medical escort.

PORTABLE OXYGEN CONCENTRATORS

Types Utilized by Sky Nurses

Inogen One G3• Small and

lightweight• Pulse Only• Settings: 1-4 LPM

Phillips Respironics• Large and

Lightweight (heavier than the Inogen One)

• Continuous and Pulse

• Settings: 1-6 LPM pulse and 1-2 LPM continuous

Portable Oxygen Concentrators

PATIENT CARE MANAGEMENT

Charting Oxygen Use

The use of oxygen must be charted in the Patient Care Management Portal.

The use of oxygen requires a physicians order. The date and time the patient was placed on the oxygen must be documented including the Oxygen Saturation at the time of administration.

If oxygen is ordered and it is not used during the medical escort, the clinician must document the reason.

Patient Care Management

The Patient

Sky Nurses

FamilyClient

Thank you. Use of Oxygen on a Plane