Preparing an Oxygen-Dependent Passenger with a Surgically Altered Airway for Commercial Air Travel.

Background: Patients with lung disease can experience hypoxemia on commercial aircraft, which can usually be corrected with supplementary oxygen. In some cases, combinations of medical conditions and inability to deliver oxygen via simple methods can complicate assessment and delivery of flight oxygen.

Case report: A 53-yr-old woman with multiple comorbidities planned a 4-h commercial flight. She has end-stage obstructive lung disease, hypercapnic respiratory failure requiring home oxygen, and previous laryngeal cancer treated by total laryngectomy, resulting in a neck stoma. She is prescribed 28% oxygen therapy via a stoma Venturi mask requiring 4 L · min-1. An airline-approved oxygen concentrator was necessary for flight, providing a maximum 3 L · min-1, so we could not assess flight oxygen without changing the delivery method, although a direct stoma oxygen connection or the use of heat and moisture exchangers (HME) had been contraindicated for normal use. Hypoxic challenge testing with various delivery methods showed that 3 L · min-1 was sufficient to maintain oxygenation safely with little risk of hypercapnia. Fitting a stoma HME with integral oxygen attachment caused accumulation of secretions and minor desaturation, although the patient could clear them spontaneously. Ultimately HME use was approved for flight only, although other methods were successfully evaluated.

Discussion: Patients with respiratory conditions are often dissuaded from flying by healthcare professionals, especially in complex cases where guidelines do not address all combinations of medical conditions. With tailored assessment and advice, surgically altered airway anatomy should not preclude commercial air travel, even if supplementary oxygen is required. Spurling KJ, Loft J, Ottun S, Moonsie I. Preparing an oxygen-dependent passenger with a surgically altered airway for commercial air travel. Aerosp Med Hum Perform. 2025; 96(5):443-446.