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Trauma patients are safe to fly 72 hours after tube thoracostomy removal

Zonies, David, MD, MPH; Elterman, Joel, MD; Burns, Christopher, MD; Paul, Vincent, MD; Oh, John, MD; Cannon, Jeremy, MD

Journal of Trauma and Acute Care Surgery: September 2018 - Volume 85 - Issue 3 - p 491–494
doi: 10.1097/TA.0000000000001976

BACKGROUND Current recommendations for safe air travel following traumatic pneumothorax are 2 to 3 weeks after radiographic resolution. These recommendations are based on several small observational studies and expert consensus, which cite a theoretical risk of recurrence and hypoxia because of decreased oxygen tension at altitude. We sought to systematically study the timing of chest drain removal after traumatic pneumothorax and risk of recurrence in relation to air travel.

METHODS A retrospective cohort study of consecutively admitted patients who sustained a traumatic chest injury treated with tube thoracostomy over a 5-year period was undertaken. Adult patients with a postremoval expiratory chest x-ray demonstrating absence of pneumothorax and at least a 24-hour observation period before flight were eligible for study. All patients were transferred to a participating medical center for continued care. In-flight medical monitoring was available for all patients. Baseline patient characteristics, interval period from drain removal to flight, in-flight medical records, and incidence of radiographic or clinical recurrence of pneumothorax at the destination facility were recorded.

RESULTS Seventy-three patients who met the inclusion criteria were studied. All were male with a median age of 24 years (interquartile range [IQR], 22–26 years), injury severity score of 30 (IQR, 24–38), and chest abbreviated injury scale value of 3 (IQR, 2–4). The majority of patients sustained a penetrating injury (74%). The median duration of tube thoracostomy was 4 days (IQR, 3–6 days). The median period between thoracostomy tube removal and flight was 2.5 days (IQR, 1.5–4 days). Twenty-nine patients (40%) remained mechanically ventilated during transport. There were no reported in-flight medical emergencies for the entire cohort. There were no reported postflight radiographic or clinical recurrences during the subsequent 30 days.

CONCLUSIONS After a 72-hour period of observation, air travel after tube thoracostomy removal appears safe for both mechanically ventilated and nonventilated patients.

LEVEL OF EVIDENCE Therapeutic, level IV.

From the Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland, Oregon (D.Z.); US Air Force School of Aerospace Medicine (D.Z.); C-STARS University of Cincinnati, Cincinnati, Ohio (J.E.); Walter Reed Medical Center, Bethesda, Maryland (C.B., J.O.); Department of Trauma and Critical Care, Landstuhl Regional Medical Center, Landstuhl, Kaiserslautern (D.Z., J.E.); Department of Radiology, Landstuhl Regional Medical Center, Landstuhl, Kaiserslautern (V.P.); Uniformed Services Univerisity of the Health Sciences, Bethesda, Maryland (J.C.); and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (J.C.).

Submitted: February 15, 2016, Revised: April 30, 2018, Accepted: May 2, 2018.

This study was presented at Western Trauma Association Annual Meeting, February 28 - March 4, 2016, Squaw Valley, California.

Address for reprints: David Zonies, MD, MPH, Division of Trauma, Critical Care and Acute Care Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098; email:

© 2018 Lippincott Williams & Wilkins, Inc.