28. Oxygen supplementation in flight - a summary
If a patient cannot walk 50 meters and walk up a staircase to the first floor without being breathless, the patient will not be accepted on scheduled or charter flights. But this one can possibly be accepted with oxygen supplementation during flight.
- For patients who are recovering from illness and who need in flight oxygen:
Consider waiting until the patient is stable and possibly no longer needs oxygen in flight.
- If in doubt whether a patient needs oxygen in flight or not: Order oxygen.
- If a patient gets oxygen on the ground, he or she must have twice in-flight.
- Commercial aircrafts can deliver a maximum of 4l oxygen/min. Only ambulance aircraft can
- Consider in-flight oxygen in patients with SAT <95%, and always order oxygen if SAT is <93%.
Forms of oxygen supply:
Oxygen bottles with fixed output, usually to 2 or 4 liters / min.
Oxygen concentrator with flow meter, usually provides 0-4 liters / minute. Requires power.
"Oxygen-on-demand". It is a very oxygen-saving system in that it only releases oxygen when the patient inspires. This allows for a much smaller amount of oxygen (about ¼) compared to the systems that give continuous flow. The oxygen is delivered via a nasal catheter. The system arrangement results in, that it cannot be used for:
- patients who cannot breathe through the nose
- troubled or confused patients
- children under 7 years
Since most airlines now use "Oxygen-on-demand", it is important to ensure that the patient does not belong to one of the above patient groups when ordering oxygen.
“Oxygen-on-demand” may well be set to deliver continuous flow, but this means that at 2 liters / minute it can only last 5 hours and at 4 liters / minute only 2½ hours. However, the longest permitted flight time for this setting is only 4 and 1½ hours respectively.
(See also Chapter 2, “Equipment supplied by commercial airline /
Equipment that must be ordered”).
- People who need oxygen in flight and who are used to administering the oxygen delivered can travel unaccompanied. If not, they should be accompanied by a person who can, usually a nurse.
Overall guidelines for who needs oxygen in flight
See Chapter 8 "Respiratory disorders" / "Pre-flight assessment”.
Recommendation for special disorders
Congestive heart failure:
NYHA class IV patients should always have oxygen in flight.
Patients who have an EF <50% after an AMI may, despite normal SAT, be at risk of desaturation in flight. So, one must be liberal in prescribing oxygen in flight to these patients.
(See also Chapter 6)
Patients with pulmonary embolism may be more easily desaturated by physical activity, although SAT is acceptable at rest. Therefore, one must be liberal in prescribing oxygen in flight to these patients.
In acute anemia where bleeding has stopped and the patient is stable, air transport should generally not be performed if the blood hemoglobin concentration is lower than
5.3 mmol / l (about 8.5 grams / 100 ml)
One should wait until hemoglobin has crossed the border again.
If it is very important to transport a patient who has a lower hemoglobin than the above limit, this may be carried out with continuous oxygen during flight.
(See also Chapter 19, "Anemia”)
001. Aeromedical Problems
013. Airline Requirements
016. Cardiac Disorders
012. Eye Disorders
013. Mental Disorders
016. Infectious Diseases
017. Orthopaedic Injuries
123. Jet Lag
124. The STEP System
Latest update: 29 - 02 - 2020