Efectul presiunii barometrice

asupra pasagerilor din cabina de

zbor

MEDICI REZIDENȚI,
A L E X A N D R U H O RA I C U
ANDREEA MÂRZA
 Statistics

Worldwide, ~1 million people are

traveling by air at any given time
>700 million Americans travel by air
in the US
~one per 10-40,000 passengers will
experience an medical emergency.
U.S. Federal Aviation Administration. Moving America safely: annual performance report 2005. http://www.faa.gov/air_traffic

Sand M et al. Surgical & Medical Emergencies on board European Aircraft:10189 cases. http://ccforum.com/content/13/1/R3
>50% of passengers age 50
or over have at
least one health issue(s)
Emergencies will become
more frequent

as % of elderly increase
Goodwyn T: In-flight Medical Emergencies: an Overview.
Brit Med J 2000; 321:1338-41
There are more deaths from
in-flight medical emergencies
than from accidents. airline
In 2006:
550 medical diversions
59% were 50 or older
63 passengers died in-flight
National Transportation Safety Board and Med Aire
In the Air,
Health Emergencies rise quietly
According to analysts, this is due to 2 factors:
79 million baby boomers are entering
retirement, but continue traveling habits
established when they were young.
Flights are going farther and lasting longer. Av.
length of a flight in 2000: 1,233 mi
Av. length of a flight in2006: 1,347
Max flying time today: 20 hrs
2 of 2
Pathophysiology
 Atmospheric Composition
The atmosphere is made up of oxygen, nitrogen, and smaller amounts of other
gases.

The percentage of these gases is fairly constant in the atmosphere up to an

altitude of 70,000 feet.

What is of concern are changes in pressure and temperature of the air during 1% other
ascent. These two factors are the cause of all physiological problems
encountered by pilots. 21% oxygen

up to
78% nitrogen
70,000 feet
What is Altitude Illness?
Cabin Pressurization to 2438 m:
What happens?
Atmospheric cabin pressure drops

Oxyhemoglobin sat
PaO2 drops from
drops from
95(12.7 kPa) to
95-100% to
65mmHg (8.7 kPa)
90%
Humpreys S et al: Effect of high Altitude Commercial Air Travel on O2 Saturation. Anesthesia 2005; 60: 458-
60
 The passenger cabin is
pressurised to 1524—
2438 m. This reduced
pressure within the
passenger cabin results
in lower syst. PaO2 and
oxyhaemoglobin (oyx-
hb). For most healthy
passengers, this results
in a decrease in the
arterial partial pressure
oxygen tension.
Silverman D, Gendeau M: Medical issues associated with commercial flights. The Lancet 2009; 373/9680: 2067-77
Passengers with pre-
existing lower sea-level
oxy-hb sat have greater
declines during flight.
E.g., a passenger with
mild COPD with a sea-
level PaO2 of 70 mm Hg
PaO2 to about 53 mm Hg
or oxy-hb sat of
approximately 84% at a
cabin altitude of 2438 m
Silverman D, Gendeau M: Medical issues associated with commercial flights. The Lancet 2009; 373/9680: 2067-77
Silverman D, Gendeau M: Medical issues associated with commercial flights. The Lancet 2009; 373/9680: 2067-77
 low cabin pressure

lower alveolar pO2 (55-70 mmHg)

lower arterial pO2 (~90%)

increasing edema

.
Curdt-Christiansen, C. et al: Principles and Practice of Aviation Medicine. World Scientific, London, 2009
Effect of Aircraft-Cabin Altitude
on Passenger Discomfort
Guidelines
Delay flying for

12 h after scuba diving (1 dive) w/o deco

24 h after several dives or 1 dive + deco

7-10 dys after diverticulitis

Medical Guidelines for Airline Travel, 2nd Edn. Aviat Space Environ Med 2003; 74 (suppl): A1-A19

2 wks after major surgery