The Practice and Clinical Impact of Two Theater Validating Flight Surgeons Employing the Tissue Oxygen Delivery Paradigm: A Three-Part Study
Abstract
This research is a first look at the clinical practice and clinical impact of the Theater Validating Flight Surgeon (TVFS). It documents two authors (WPB and LWS) successive deployments as TVFSs where they developed/implemented the so-called tissue oxygen delivery (DO2) paradigm. Calculation of DO2 guided their evaluation/validation of evacuated patients. Part 1 was a descriptive analysis of their patients clinical variety and severity as well as an accounting of the prescriptions employed by them, the most unique being the cabin altitude restriction (CAR). Part 2 was a population-level hypothesis-generating ecological study detecting a significant (p = 0.034) inverse relationship between the rates of CAR prescribing and postflight complications. As the rate of CAR prescribing rose, the rate of postflight complications dropped. Part 3 was a dual case-control study focusing on the CAR prescription. Although CAR patients were sicker, their postflight clinical outcomes were comparable to Non-CAR patients. At the same time, Non-CAR patients flown with a CAR appeared just as sick as Non-CAR patients; however, the Non-CAR patients flown with a CAR had clearly superior postflight clinical outcomes. It seemed that the CAR prescription normalized CAR patients into less sick Non-CAR patients and brought Non-CAR patients into a less morbid state. Specific flight stressors dropping DO2 include hypoxia, vibration, and hypobaria. Hypoxia decreases oxygen availability; vibration and hypobaria increase intercapillary distance (aka tissue edema). A cut in oxygen and a greater tissue diffusion distance means DO2 will drop. Using standard physiological equations, the TVFS can calculate DO2 and then manipulate it by prescribing supplemental oxygen, transfusion, and/or CAR. In conclusion, this research is not only a first look at the clinical practice of the TVFS, but also documentation of the TVFSs positive clinical impact.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jan 07, 2020
- Accession Number
- AD1091451
Entities
People
- Anil Cherian
- Brittany Fouts
- Danny Smith
- David Burch
- Esther Burlingame
- Jennifer Serres
- Justin Lovuolo
- Kenneth Egerstrom
- Lawrence Steinkraus
- William Butler