title: Expansion of postoperative pneumothorax and pneumomediastinum: determining when it is safe to fly.
abstract: BACKGROUND
  The possibility of expansion of pneumothorax (PTX) and/or pneumomediastinum (PMED) during commercial flights makes air travel after thoracic surgery particularly worrisome. Guidelines from the Aerospace Medical Association (AsMA) suggest delaying air travel 2 to 3 wk following uncomplicated thoracic surgery and 1 wk following radiographic resolution of PTX; they also state that PTX is an "absolute contraindication" to air travel. However, both AsMA guidelines and thoracic surgeons' recommendations for postoperative air travel require further examination.
  
  
  METHODS
  We reviewed the literature looking for evidence supporting official guidelines and conducted a survey of U.S. thoracic surgeons about their recommendations for air travel by patients with postoperative PTX and/or PMED.
  
  
  RESULTS
  We found no experimental evidence supporting the AsMA guidelines. Of the 68 thoracic surgeons who returned our questionnaire, 44% recommended that patients wait variable periods of time of up to 42 d (13.8 +/- 11.6 d) following complete resolution of PTX prior to air travel, while 46% of them allowed their patients to fly with some degree of PTX. Following mediastinoscopy, 76.9% of the surgeons allowed their patients to fly without delay, even with PMED. The only adverse in-flight event reported was a case of thoracic pain during ascent.
  
  
  CONCLUSIONS
  A wide variability exists among thoracic surgeons regarding their recommendations for air travel by patients with postoperative PTX and/or PMED. Both AsMA guidelines and surgeons' recommendations should rely more on scientific evidence. Studies of PTX and PMED expansion during simulated flight are needed to develop better guidelines.
authors.affiliation: Department of Anesthesiology, Pain and Perioperative Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Szymanski
authors.forename: Michael T
authors.initials: MT
authors.lastname: Jaklitsch
authors.forename: Francine
authors.initials: F
authors.lastname: Jacobson
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Mullen
authors.forename: Massimo
authors.initials: M
authors.lastname: Ferrigno
mesh_terms: D000337:Aerospace Medicine; D000401:Aircraft; D006306:Health Surveys; D006801:Humans; D008478:Mediastinal Emphysema / Q000209:etiology*; D011030:Pneumothorax / Q000209:etiology*; D011182:Postoperative Care; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D012449:Safety; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D019616:Thoracic Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D013997:Time Factors; D014195:Travel