title: Air transport of patients with pneumothorax: is tube thoracostomy required before flight?
abstract: OBJECTIVE
  It is conventionally thought that patients with pneumothorax (PTX) require tube thoracostomy (TT) before air medical transport (AMT), especially in unpressurized rotor-wing (RW) aircraft, to prevent deterioration from expansion of the PTX or development of tension PTX. We hypothesize that patients with PTX transported without TT tolerate RW AMT without serious deterioration, as defined by hypotension, hypoxemia, respiratory distress, intubation, bag valve mask ventilation, needle thoracostomy (NT), or cardiac arrest during transport.
  
  
  METHODS
  We conducted a retrospective review of a case-series of trauma patients transported to a single Level 1 trauma center via RW with confirmed PTX and no TT. Using standardized abstraction forms, we reviewed charts for signs of deterioration. Those patients identified as having clinical deterioration were independently reviewed for the likelihood that the clinical deterioration was a direct consequence of PTX.
  
  
  RESULTS
  During the study period, 66 patients with confirmed PTX underwent RW AMT with an average altitude gain of 1890 feet, an average barometric pressure 586-600 mmHg, and average flight duration of 28 minutes. All patients received oxygen therapy; 14/66 patients (21%) were supported with positive pressure ventilation. Eleven of 66 patients (17%) had NT placed before flight and 4/66 (6%) had NT placed during flight. Four of 66 patients (6% CI0.3-11.7) may have deteriorated during AMT as a result of PTX; all were successfully managed with NT.
  
  
  CONCLUSIONS
  In this series, 6% of patients with PTX deteriorated as result of AMT without TT, yet all patients were managed successfully with NT. Routine placement of TT in patients with PTX before RW AMT may not be necessary. Further prospective evaluation is warranted.
authors: University of New Mexico Health Science Center.
authors: Darren
authors: D
authors: Braude
authors: University of New Mexico Health Science Center. Electronic address: dtutera13@gmail.com.
authors: Dominic
authors: D
authors: Tutera
authors: University of New Mexico Health Science Center.
authors: Issac
authors: I
authors: Tawil
authors: University of New Mexico Health Science Center.
authors: Gregory
authors: G
authors: Pirkl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D000399:Air Pressure; D000531:Altitude; D002648:Child; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control; D000860:Hypoxia / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000150:complications / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D013907:Thoracostomy / Q000379:methods; D013997:Time Factors; D055815:Young Adult