<![CDATA[Acute respiratory distress syndrome (ARDS) is a clinical syndrome of acute respiratory failure characterized by arterial hypoxemia and bilateral pulmonary opacities. In recent years, the incidence of ARDS has rapidly increased due to Coronavirus Disease 2019 (COVID-19). This has resulted in an increased need for patient referral to more adequate health care facilities using air ambulance through air medical evacuations. The purpose of this study is to synthesize the aeromedical concerns in ARDS patients undergoing air medical evacuation, focusing on physiological challenges and mechanical ventilation issues in flight. Acute hypobaric hypoxia that occurs during air medical evacuation inside the cabin (altitude 6,000–8,000 ft) will trigger a hyperventilation response that can lead to respiratory alkalosis. This condition will not only worsen the hypoxemia state but also deteriorate the patient’s clinical symptoms. Additionally, changes in altitude and atmospheric pressure inside the aircraft cabin also pose risks to patients using invasive mechanical ventilation. Not only can it disrupt the settings of medical equipment, but it can also cause pulmonary barotrauma, which can lead to pneumothorax. To prevent these various impacts, air medical evacuation must be carried out by a multidisciplinary team with considerations for the use of medications and manoeuvres for invasive mechanical ventilation. The key parameters to assess fitness-to-fly among ARDS patients include the vital signs, heart rhythm, tidal volume, end-tidal carbon dioxide, neuromuscular blockade, inspiratory pressure peak, along with some parameters related to the use of invasive mechanical ventilation, such as oxygen pressure, FiO2, atmospheric pressure, power status, turbine function, and malfunction indicator.]]>
