Chest
Volume 133, Issue 4, April 2008, Pages 914-919
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Original Research
Air Travel
Definition of Cutoff Values for the Hypoxia Test Used for Preflight Testing in Young Children With Neonatal Chronic Lung Disease

https://doi.org/10.1378/chest.07-1198Get rights and content

Background

The hypoxia test can be performed to identify potential hypoxia that might occur in an at-risk individual during air travel. In 2004, the British Thoracic Society increased the hypoxia test cutoff guideline from 85 to 90% in young children. The aim of this study was to investigate how well the cutoff values of 85% and 90% discriminated between healthy children and those with neonatal chronic lung disease (nCLD).

Methods

We performed a prospective, interventional study in young children with nCLD who no longer required supplemental oxygen and healthy control subjects. A hypoxia test (involving the administration of 14% oxygen for 20 min) was performed in all children, and the nadir in pulse oximetric saturation (Spo2) recorded.

Results

Hypoxia test results were obtained in 34 healthy children and 35 children with a history of nCLD. Baseline Spo2 in room air was unable to predict which children would “fail” the hypoxia test. In those children < 2 years of age, applying a cutoff value of 90% resulted in 12 of 24 healthy children and 14 of 23 nCLD children failing the hypoxia test (p = 0.56), whereas a cutoff value of 85% was more discriminating, with only 1 of 24 healthy children and 6 of 23 nCLD children failing the hypoxia test (p = 0.048).

Conclusion

In the present study, using a hypoxia test limit of 90% did not discriminate between healthy children and those with nCLD. A cutoff value of 85% may be more appropriate in this patient group. The clinical relevance of fitness to fly testing in young children remains to be determined.

Section snippets

Subjects

Children with a history of nCLD, as defined by Bancalari et al,10 who were < 5 years of age were recruited for the study. Children with nCLD must have been not received supplemental oxygen for at least 4 weeks prior to study enrollment. Healthy children, who were born after 37 weeks of gestation were completed and were between the ages of 1 week and 5 years, were also invited to participate in the study if they had already flown or were planning to fly in the near future. Written consent for

Results

A total of 88 children were studied, 19 of whom failed to complete the test. These children were aged 9 to 51 months of age (mean age, 27 months) and could not be persuaded to keep a facemask sealed to their face for the required 20 min; consequently, they were excluded from further analysis. Two of the oldest children were deaf and/or autistic, and if excluded, the children unwilling to cooperate with the hypoxia test were aged 9 to 40 months (mean age, 23 months). The remaining 69 successful

Discussion

This study of the responses of young children with a history of nCLD as well as healthy control subjects to a 20-min hypoxia challenge demonstrated that a cutoff oxygen saturation value of 85% best discriminates between these two groups. The 2004 revised BTS guideline recommending a 90% cutoff for oxygen saturation8 poorly discriminated between healthy children and those with nCLD, with 35% and 40%, respectively, of children failing the test. However, using the previous limit of 85% resulted in

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    Since not all centres have access to a body plethysmograph, an alternative method using a tight-fitting non-rebreathing facemask incorporating a one-way valve assembly has been devised, through which 14% oxygen is administered. Much of the paediatric work has come from one centre in Perth, Australia [5–7,10]. However, the validity of this technique may be an issue.

  • Air travel and the risks of hypoxia in children

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    This decision was acknowledged as being based on limited evidence. Martin et al28 performed flight simulation tests in 24 term-born healthy children and 23 children with a history of bronchopulmonary dysplasia (BPD) aged five years or less, showing that if cut-off level for “failing” the hypoxia test was set at 90%, 12 of the 24 healthy and 14 of the 23 BPD children failed. Conversely, at a cut-off SpO2 level of 85%, only 1 of the 24 healthy and 6 of the 23 children with BPD failed the hypoxia test.

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The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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