II. Background: Air Travel

  1. FAA requires cabin pressure <8000 feet (2438m)
    1. Most airplane cabins are pressurized to 6500 feet (+/- 1000 feet)
    2. 10% of airplane cabins are pressurized to 8000 feet
  2. Oxygen Saturation on airplane drops by 3-4% or more
    1. Atmospheric oxygen pressure may drop from 95 mmHg at sea level to 55 mmHg (90% O2Sat) at 8000 feet
    2. May exacerbate patients already hypoxic (e.g. severe COPD)
    3. Portable oxygen in flight is recommended if resting Oxygen Saturation <92% at sea level

III. Precautions

  1. Do not remove drainage tubes immediately prior to air travel (risk of significantly increased pressure)

IV. Contraindications: Cardiac conditions

  1. Acute Myocardial Infarction
    1. First 4 to 6 weeks after Myocardial Infarction
      1. No travel above 2,000 ft (610m)
    2. Subsequent (walk 328 ft or 100 m, climb 12 steps)
      1. Limit = 8,000 feet (2438m)
  2. Congestive Heart Failure
    1. No air travel for 2 weeks after decompensation
    2. Exception: Oxygen and <10,000 ft (3048m)
  3. Air travel is safe in stable cardiovascular disease
    1. Use below the knee Compression Stockings
    2. Walk inside the cabin
    3. Avoid Alcohol and stay well hydrated
    4. Possick (2004) Ann Intern Med 141:148-54 [PubMed]

V. Contraindications: Respiratory

  1. Chronic Obstructive Pulmonary Disease (COPD)
    1. No air travel if Vital Capacity <50% of predicted
  2. Pneumothorax
    1. No flight for 10 days after resolution
  3. Asthma
    1. No restriction if stable

VI. Contraindications: Pregnancy

  1. Physician must certify air travel after 36 weeks
  2. No surface travel above 15,000 feet (4572m)

VII. Contraindications: Hematologic

  1. Anemia
    1. Oxygen needed if Hemoglobin <8.5 g/dl
  2. Hemoglobinopathies (Sickle Cell/Thalassemia)
    1. Avoid air travel if SS or SC variant
    2. No pressurized aircraft travel >22,000 ft (6705m)

VIII. Contraindications: Thromboembolic disorders or patient over age 50 years

IX. Contraindications: Postsurgical

  1. Abdominal: No air travel for 7 days after laparoscopy
    1. Some recommendations for no travel for 10-14 days after other abdominal surgeries
  2. Colostomy or Ileostomy
    1. Use extra large bags
  3. Ophthalmologic surgery
    1. No travel above cabin pressure >5000 ft (1524m)

X. Contraindications: Recent Scuba Diving

  1. No travel for 24 hours after decompression dive
  2. No travel for 12 hours after non-decompression dive

XI. References

  1. Lin and Delaney in Herbert (2015) EM:Rap 15(5): 7-8
  2. Leibman and Orman in Herbert (2014) EM:Rap 14(9): 8

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