Air Travel Restriction


Air Travel Restriction, Contraindications to Air Travel

  • 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 60 mmHg (90% O2Sat) at 8000 feet
    2. May exacerbate patients who are already hypoxic (e.g. severe COPD)
    3. Portable oxygen in flight is recommended if resting Oxygen Saturation <92% at sea level
      1. However Pulse Oximetry and FEV1 do not adequately predict in-flight desaturation
    4. Hypoxia Altitude Simulation Test is preferred for predicting in-flight desaturation
      1. Hypoxia Altitude Simulation Test with <50 mmHg at any time predicts Supplemental Oxygen need
  • Precautions
  1. Do not remove drainage tubes immediately prior to air travel (risk of significantly increased pressure)
  • Management
  • Cardiac Conditions
  • Management
  • Respiratory
  • Management
  • Pregnancy
  1. See Travel in Pregnancy
  2. Physician must certify air travel after 36 weeks
  3. No surface travel above 15,000 feet (4572m)
  • Management
  • Head and Neck
  1. Upper respiratory congestion (Sinusitis, Allergic Rhinitis)
    1. Consider preflight Topical Decongestant (e.g. Oxymetazoline, Intranasal Phenylephrine)
  2. Equalizing ear pressure on flight descent
    1. Adults and older children may chew gum or food, or perform frequent Swallowing
    2. Infants may be given Bottle Feeding or Pacifier
  3. Otitis Media
    1. Delay air travel if possible for 36 hours after resolution
  4. Air Sickness or Motion Sickness
    1. Transdermal Scopolamine
    2. First Generation Antihistamine (e.g. Diphenhydramine)
    3. Limit meals to small, more frequent
    4. Avoid Alcohol
  5. Jaw Fracture with wired closure
    1. Avoid flying for 1-2 weeks
    2. Jaw wiring should be temporarily replaced with elastic banding to allow for inflight Nausea and vomting
  6. Ophthalmologic surgery
    1. Avoid air travel within 2 weeks of Retinal Detachment intervention
    2. Avoid air travel for up to 6 weeks after open globe surgery
  7. Other eye disorders
    1. Stable Glaucoma may undergo air travel without restriction
  • Management
  • Hematologic
  1. Thromboembolic disorders, patients over age 50 years or Venous Thromboembolism history
    1. See DVT Prevention in Travelers
    2. Consider Compression Stockings in flights longer than 5 hours
    3. Perform isometric lower extremity Exercises while seated
    4. Walk frequently on flight (10-15 minutes every 2 hours)
    5. Maximize hydration and avoid Alcohol
    6. Consider Low Molecular Weight Heparin or DOAC on the day of travel in those at high risk for DVT
  2. Anemia
    1. Caution and consider Supplemental Oxygen if Hemoglobin <8.5 g/dl
    2. Avoid air travel if Hemoglobin <7.5 g/dl (esp. if elderly or acute Anemia)
  3. Hemoglobinopathies (Sickle Cell/Thalassemia)
    1. Delay air travel >10 days from time of last Sickle Cell Crisis
    2. Avoid air travel if Sickle Cell Anemia, recent transfusion and Hemoglobin <7.5 g/dl
  • Management
  • Gastrointestinal and Genitourinary
  1. Abdominal procedures (risk of trapped gas related complications)
    1. Avoid air travel for 1-2 weeks after open abdominal surgery
    2. Avoid air travel for at least 24 hours after laparoscopy and until bloating and Abdominal Distention resolve
    3. Avoid air travel for at least 24 hours after Colonoscopy and until bloating resolves
  2. Colostomy or Ileostomy
    1. Use extra large bags
  3. Acute gastrointestinal conditions (e.g. Small Bowel Obstruction, acute Gastrointestinal Bleeding)
    1. Avoid air travel until stabilized
  4. Foley Catheter (and other indwelling devices)
    1. Balloons should be filled with saline or other liquid (not air) to prevent expansion in flight
  • Management
  • Orthopedics
  1. Fixed Casts
    1. "Bivalve" Cast (split in two halves) and secured with ace wrap is recommended to allow for swelling
  2. Air Casts
    1. May be contraindicated in flight
    2. If allowed, release small amount of air prior to flight to allow for expansion
  3. Prosthetic limb
    1. Avoid metal detector (use alternative screening)
  1. See Scuba Diving
  2. No travel for 24 hours after decompression dive
  3. No travel for 12 hours after non-decompression dive
  • 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
  3. Powell-Dunford (2021) Am Fam Physician 104(4): 403-10 [PubMed]