Respiratory failure and air travel

This time of year, when people are busy planning their vacations, raises questions about the safety of air travel for people with respiratory problems. Aircraft cabins are pressurized to an altitude of 1,500 to 2,450 meters. At 2,450 meters, barometric pressure is 15% lower than at sea level, exposing people with respiratory insufficiency to various problems (dyspnea, headaches, fatigue, etc.) {1} .

The portability of oxygen concentrators, advances in ventilator batteries, and legislation (such as the US Air Carrier Access Act of 2009) have eased the logistical burden on patients {2} . However, a trip must be planned and prepared in advance, starting with providing the traveler, their doctor, and their home healthcare provider (HCP) with the right information {3;4}.

Flying under NIV or O2 : under what conditions?

The pulmonary specialist must ask themselves two questions:
1. Does this patient require a hypoxia test prior to air travel?
2. Should they use their respiratory assistance device during the flight?
To answer this question, there are reference documents, such as: the recommendations of the British Thoracic Society (updated in 2022) {4;5} including a decision-making algorithm, as well as the expert conference “Air travel and respiratory diseases,” organized by three learned societies, including the Société de Pneumologie de Langue Française (2007) {6}.

In short, and excluding special cases:

• Hypoxia tests are generally recommended for patients with SpO₂ below 95%.
• Patients on long-term oxygen therapy will need to travel by air while on oxygen.
• Ventilation during the flight is necessary for patients who are ventilated for more than 12 hours per day, regardless of the duration of the flight. Patients who are ventilated for less than 12 hours per day must always have access to their ventilator in the cabin and be ventilated during the flight if the journey lasts more than 6 hours.{5}.

Respective roles {1;6;7}

If, after medical evaluation, the flight is authorized but must take place with respiratory support, it is important that:
• For the doctor: provide a medical certificate and prescription to the patient.
• For the patient: contact the airline to ensure that the equipment is permitted on board, notify the service provider of their trip, arrange for assistance at the airport, and find out about repatriation options and insurance to take out.
• For the service provider: ensure continuity of the patient’s treatment (in particular oxygen therapy until the airline takes over), check that they are familiar with the rules for using and transporting the equipment, and provide them with a customs certificate for the medical devices and a sufficient number of batteries for the journey.

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