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Pressure breathing in fighter aircraft for G accelerations and loss of cabin pressurization at altitude - a brief review

[La respiration sous pression dans les avions de chasse soumis à des accélérations G et à la perte de pressurisation de la cabine en altitude - une étude sommaire]

From the Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville South, Australia.

Address correspondence to: Dr. John Pfitzner, Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA 5011, Australia. Phone: +61-8-8222-6000; Fax: +61-8-8222-7065; E-mail: pfitznerwines{at}ozemail.com.au

Purpose: The purpose of this brief review is to outline the past and present use of pressure breathing, not by patients but by fighter pilots.

Source: Of the historical and recent references quoted, most are from aviation-medicine journals that are not often readily available to anesthesiologists.

Principal findings: Pressure breathing at moderate levels of airway pressure gave World War II fighter pilots a tactical altitude advantage. With today’s fast and highly maneuvrable jet fighters, very much higher airway pressures of the order of 8.0 kPa ( 60 mmHg) are used. They are used in conjunction with a counterpressure thoracic vest and an anti-G suit for the abdomen and lower body. Pressurization is activated automatically in response to +Gz accelerations, and to a potentially catastrophic loss of cabin pressurization at altitude. During +Gz accelerations, pressure breathing has been shown to maintain cerebral perfusion by raising the systemic arterial pressure, so increasing the level of G-tolerance that is afforded by the use of anti-G suits and seat tilt-back angles alone. This leaves the pilot less reliant on rigorous, and potentially distracting, straining maneuvers. With loss of cabin pressurization at altitude, pressure breathing of 100% oxygen at high airway pressures enables the pilot’s alveolar PO₂ to be maintained at a safe level during emergency descent.

Conclusion: Introduced in military aviation, pressure breathing for G-tolerance and pressure breathing for altitude presented as concepts that may be of general physiological interest to many anesthesiologists.