Hypoxemia during aeromedical evacuation of the walking wounded

Johannigman, Jay A.; Gerlach, Travis; Cox, Daniel; Juhasz, Jon; Britton, Tyler; Elterman, Joel; Rodriquez, Dario; Blakeman, Thomas; Branson, Richard D.

doi:10.1097/ta.0000000000000736

Cited by 24 publications

(17 citation statements)

References 10 publications

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“…In the latest guidelines, hyperoxemia is defined as an S pO 2 > 94% for the general population and > 92% for patients with COPD. [5][6][7][8][9][11][12][13][14][15][16][17]19 An S pO 2 target of 88-92% reduced mortality in patients with respiratory distress in comparison with current practices of an S pO 2 frequently > 92% and oxygen flows ranging from 8 to 15 L/min. 8,9,10,15,19 In most cases, the frequent liberal use of oxygen leads to detrimental consequences, 6,7,9,11,14,17,[19][20][21][22] particularly in patients with trauma or respiratory distress and during myocardial infarction.…”

Section: Introductionmentioning

confidence: 89%

“…20 Very low S pO 2 are frequently encountered at altitude, and S pO 2 targets between 88% and 95% are recommended in mechanically ventilated patients with ARDS. 12,33 Although not recommended for all patients due to the lack of data, it was previously reported that moderate hypoxemia is safe for short-term exposure, even in the case of critically ill patients with septic shock. 34 There are mechanisms to compensate for acute hypoxemia and avoid cell hypoxia, such as increased cardiac output, vasodilatation, reduced cellular metabolism, and long-term mechanisms such as increased hemoglobin concentration.…”

Section: Impact Of the S Po 2 Target On Oxygenmentioning

confidence: 99%

“…3,4 Oxygen is frequently used to correct hypoxemia, defined in the latest guidelines as a S pO 2 < 90% for the general population and < 88% for COPD patients, 5,6 in military and non-military settings. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In 2015, Johannigman et al 12 reported that 90% of military subjects experienced at least one desaturation event with an S pO 2 < 90% and that more than half of the subjects had S pO 2 values < 85% during aeromedical evacuations. Numerous studies have highlighted the requirement for accurate oxygen administration to avoid both hypoxemia and hyperoxemia.…”

Section: Introductionmentioning

confidence: 99%

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Oxygen Conservation Methods With Automated Titration

et al. 2020

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BACKGROUND: Oxygen titration is recommended to avoid hyperoxemia and hypoxemia. Automated titration, as well as the S pO 2 target, may have an impact on oxygen utilization, with potential logistical effects in emergency and military transportation. We sought to assess the oxygen flow required for different S pO 2 targets in spontaneously breathing subjects, and to evaluate individualized automated oxygen titration to maintain stable oxygenation in subjects with COPD and healthy subjects with induced hypoxemia. METHODS: In the first part of the study, oxygen flow was evaluated in hospitalized subjects for different S pO 2 targets from 90% to 98%. Oxygen requirements to reach these targets were determined using a device that automatically adjusts oxygen flow every second on the basis of the S pO 2 target. In the second part of the study, the same automated oxygen titration method was used to correct hypoxemia in subjects with COPD and in healthy subjects with induced hypoxemia while the subjects wore a gas mask. Oxygen flow, S pO 2 , and heart rate were continuously recorded. RESULTS: Thirty-six spontaneously breathing hospitalized subjects were included in the first part of the study. Oxygen flow was reduced more than 6-fold when the S pO 2 target was decreased from 98% to 90%. The second part of the study included 15 healthy and 9 subjects with stable COPD. In healthy subjects, heterogeneous oxygen flows were required to correct induced hypoxemia (0.2-2.5 L/min). In subjects with COPD, oxygen flow varied from 0 L/min (in 9 of 18 tested conditions) to 2.9 L/min. CONCLUSIONS: Significant reductions in the amount of oxygen delivered could be obtained with optimized S pO 2 targets. Oxygen delivery through a gas mask to correct hypoxemia is feasible, and automated oxygen titration may help individualize oxygen administration and reduce oxygen utilization. (ClinicalTrials.gov registration: NCT02782936, NCT02809807.

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Section: Introductionmentioning

confidence: 89%

Section: Impact Of the S Po 2 Target On Oxygenmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oxygen Conservation Methods With Automated Titration

et al. 2020

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“…13 The partial pressure of oxygen is 149 mm Hg at sea level, but 108 mm Hg at 8000 feet, resulting in a lower fraction of inspired oxygen. 14,15 This is sufficient for healthy individuals but frequently results in short events of hypoxemia (oxygen saturation <90%) in some patients, even though it remains unclear whether it may be injurious without a parenchymal brain lesion. 14,15 Therefore, a continued monitoring of oxygen saturation is necessary and an oxygen supplementation is required.…”

Section: Discussionmentioning

confidence: 99%

Transoceanic Management and Treatment of Aneurysmal Subarachnoid Hemorrhage

Mejdoubi

Schertz

Zanolla

et al. 2018

Stroke

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Background and Purpose-Because of the small number of yearly cases of ruptured cerebral aneurysms, endovascular treatment is not performed in Martinique. Therefore, patients from Martinique are sent 7000 km to Paris on commercial flights as soon as possible, where treatment is performed. Nontransportable patients are treated locally with either surgery or symptomatic care. The objective of our study was to assess patient outcomes and safety of this treatment strategy. Methods-We retrospectively examined all cases of aneurysmal subarachnoid hemorrhage in Martinique diagnosed during 2004 to 2013. Medical case records were searched for the type and location of treatment, clinical status, and transfer duration. Results-A total of 119 patients had an aneurysmal subarachnoid hemorrhage during the 10-year period. Of these, 91were transferred to Paris, 12 were surgically treated locally, and 16 received symptomatic treatment. None of the transferred patients experienced any hemorrhagic recurrence, and none suffered a significant complication related to the air transportation. The median time between aneurysmal subarachnoid hemorrhage diagnosis and arrival at the referral center was 32 hours. The 30-day case fatality rate for treated cases was 14.6% (8.8% for those treated in Paris and 58.3% for those treated locally). Conclusions-Our treatment strategy for aneurysmal subarachnoid hemorrhage resulted in a 30-day case fatality rate similar to those observed elsewhere, despite an 8-hour flight and a median treatment delay of 32 hours. This strategy therefore seems to be safe and reliable for isolated regions with small populations.

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“…Research studies have identified potential negative effects of altitude on brain injuries, 8 suboptimal documentation of pain assessment and treatment during transport, 9 and more prevalent than expected hypoxemia during routine transports. 10 In addition, it has been found that low hemoglobin measures are not associated with adverse outcomes 11 and that the use of ketamine to manage pain in the en route care setting can be safe. 12 Despite the incremental advances that have been made, nurses in the acute care setting have an important perspective to identify potential problems or sources of error that could negatively affect patients and their recovery process.…”

mentioning

confidence: 99%