En-Route Care in the Air: Snapshot of Mechanical Ventilation at 37,000 Feet
AIR FORCE CENTER FOR SUSTAINMENT OF TRAUMA AND READINESS SKILLS CINCINNATI OHIO
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Evacuation of seriously wounded service members requiring mechanical ventilation in aircraft where low light, noise, vibration, and barometric pressure changes create a unique clinical environment. Our goal was to evaluate ventilatory requirements, oxygenation, and oxygen use in flight and assess the feasibility of a computer interface. A personal computer was integrated with the pulse oximeter and ventilator data port used in aeromedical evacuation from Iraq to Germany. Ventilator settings, inspired oxygen FiO2, tidal volume VT, respiratory rate RR, minute ventilation VE, monitored values, heart rate HR, and oxygen saturation SpO2, were recorded continuously. Additional data was obtained through the U.S. Air Force USAF Transcom Regulation and CommandControl Evacuation System TRAC2ES and the U. S. Army Institute of Surgical Research Joint Theater Trauma Registry databases. During a 4 month time frame 117 hours of continuous recording was accomplished in 22 patients. All patients survived transport. There were 32 changes to FiO2, 18 changes to PEEP, 26 changes to RR, and 20 changes to VT during flight. Five patients underwent no recorded changes in flight. Three desaturation events 90 were recorded lasting 35, 115, and 280 seconds. Recorded ventilatory changes averaged less than 1 0.82 per hour of recorded flight with FiO2 being the most common. Conclusions A computer interface is feasible in the austere aeromedical environment. Implications to military operations and civilian homeland defense include understanding casualty oxygen requirements for resource planning in support of aeromedical evacuation. Portable oxygen generation systems may be able to provide adequate oxygen flow for transport, reducing the need for compressed gas. Future studies of oxygen conservation systems including closed loop control of FiO2 are warranted.
- Medicine and Medical Research
- Medical Facilities, Equipment and Supplies
- Biomedical Instrumentation and Bioengineering