Aeromedical Transport of a Patient with Massive Chylothorax Following Pneumonectomy for Mesothelioma

DEVIRI E, CAINE Y, HENIG-HADAR A, SAUTE M, Isu TOV, E. Aeromedical transport of a patient with massive chylothorax following pneumonectomy for mesothelioma. Aviat Space Environ Med 2009; 80:981-3. Introduction: Long-distance transportation of a patient in all unstable condition is a challenging operation When circumstances require using a commercial flight it is even more so Case Report: A 57-yr-old man in Israel underwent extrapleural pneumonectomy for mesothelioma, following which lie developed a massive chylothorax of more than 6 L . 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 non-medical 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 lie was treated with intravenous fluids, chest physiotherapy, and oxygen In addition, fibrin clots blocked the drainage system on tow 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 Conclusion: 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.