From the Guidelines
To prevent barotrauma while flying, patients with a tracheostomy should have the air in the cuff of their tube replaced with an equal volume of saline before boarding, as recommended by the British Thoracic Society 1. This is particularly important for patients on permanent ventilation, as the reduced barometric pressure at altitude can cause the air in the cuff to expand, leading to potential complications.
- The British Thoracic Society guidelines emphasize the importance of proper preparation for patients with respiratory disease planning air travel, including those with tracheostomies 1.
- The guidelines also highlight the need for medical escorts to be competent in managing emergency situations, such as changing the tube, operating suction, and providing emergency ventilation if electrical power fails 1.
- Additionally, the guidelines recommend that patients with severe COPD be assessed before flying, and that those who require in-flight oxygen should receive oxygen when visiting high-altitude destinations 1.
- However, the most recent and highest-quality study on preventing barotrauma while flying is not directly related to the provided evidence, and therefore, the recommendation is based on the available evidence from the British Thoracic Society guidelines 1.
- It is essential to prioritize the patient's safety and take necessary precautions to prevent barotrauma, especially for those with pre-existing medical conditions.
- The provided evidence from other studies, such as those related to venous thromboembolic disease and heart failure, is not directly relevant to preventing barotrauma while flying 1.
From the Research
Prevention of Barotrauma while Flying
To prevent barotrauma while flying, several methods can be employed:
- Taking oral pseudoephedrine 30 minutes before flight departure, as studies have shown that it decreases the incidence of middle ear barotrauma associated with ambient pressure changes during air travel 2, 3, 4
- Using pressure-equalizing techniques, although there is insufficient evidence to support the efficacy of nasal balloon inflation or pressure-equalizing ear plugs for the prevention of otic barotrauma 4
- Considering the use of vasoconstrictor drugs, as mentioned in the management of barotrauma 5
Medications for Prevention
The use of oral pseudoephedrine has been studied extensively:
- A dose of 120 mg pseudoephedrine has been shown to be effective in preventing otic barotrauma in adults 2, 3, 4
- However, oral pseudoephedrine (1 mg/kg) does not appear to be effective in children 4
- Pseudoephedrine has a long history of medical use and is helpful in treating symptoms of the common cold and flu, sinusitis, asthma, and bronchitis, but it also has risks associated with its misuse 6
Other Considerations
It is essential to note that barotrauma can be caused by the effects of pressure changes on gas-containing body spaces, not in communication with the environment, and can affect various parts of the body, including the external ear, middle ear, para-nasal sinuses, lungs, gut, and abscess cavities 5