Aeromedical transport of a patient with massive chylothorax following pneumonectomy for mesothelioma.
BACKGROUND
Long-distance transportation of a patient in an unstable condition is a challenging operation. When circumstances require using a commercial flight it is even more so.


METHODS
A 57-yr-old man in Israel underwent extrapleural pneumonectomy for mesothelioma, following which he developed a massive chylothorax of more than 6 L x d(-1). Due to the failure of medical treatment and the high operative risk under such conditions, it was decided to transfer him to the United States by commercial flight for a percutaneous, fluoroscopy-guided closure of the thoracic duct. The patient was accompanied by a physician and a nonmedical assistant and occupied a first-class seat enclosed by curtains. He arrived at the departure airport in a hypovolemic state with low cardiac output and blood pressure of 78/60 Torr. During the flight he was treated with intravenous fluids, chest physiotherapy, and oxygen. In addition, fibrin clots blocked the drainage system on two occasions, requiring corrective action. On arrival in the United States the patient's condition had improved: his blood pressure was 123/91 Torr with a capillary oxygen saturation of 95% without supplementary oxygen. During the 18 h in transit (11 h in flight) he had lost more than 5 L of lymph.


CONCLUSIONS
Under carefully controlled circumstances it is possible to use commercial flights to transport patients whose condition is unstable and complicated. Safety can be increased by focusing on the specific problems associated with the clinical condition and anticipating possible adverse events during the flight.
Deviri
Ehud
E
Airmed Airborne Medical Services, Hod Hasharon, Israel. udideviri@hotmail.com
Caine
Yehezkel
Y
Henig-Hadar
Avinoam
A
Saute
Milton
M
Ish Tov
Eytan
E
D000337:Aerospace Medicine; D017732:Air Ambulances; D002916:Chylothorax / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007557:Israel; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery*; D008654:Mesothelioma / Q000601:surgery*; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D013396:Suction; D014481:United States