PubMed · 13297044
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P H DAMSTE. 1955. [Between pilot and plane].. https://pubmed.ncbi.nlm.nih.gov/13297044/
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OBJECTIVES: To quantify the risk of venous thromboembolism (VTE) following air travel and assess methods of prevention. DESIGN: Review of literature. METHODS: We reviewed Pubmed, Medline, Embase and Cochrane Databases for studies that have assessed the risk of VTE associated with air travel. RESULTS: There is an association of VTE with air travel with pooled odds ratio of 1.59 (confidence interval 1.04-2.43) from three case control studies and relative risk of 2.93 (confidence interval 1.5-5.58) from two controlled cohort studies. The incidence of symptomatic pulmonary embolism (PE) is extremely low but there is substantial increase when the distance travelled is more than 5,000 miles (1.5 PE per million passengers) or time of flight is more than 8h duration (2.57 PE per million passengers). The quantitative risk of lower limb venous thrombosis in high-risk subjects is 5% per flight and 1.6% per flight for low risk subjects following long haul flights. All six randomised trials to test the below knee compression stockings with ankle pressures of 14-30 mmHg have shown reduction in lower limb venous thrombosis. CONCLUSION: VTE is more common in those with additional risk factors when the risk is about 5% per air travel for long haul flights. Class I or II below knee compression stockings are effective in the prevention of lower limb venous thrombosis.
It is estimated that at least one billion passengers travel by air every year. It is predicted that this number will double in the future, including an increasing number of aged passengers. It is further estimated that for every ten million passengers, 225 acute in-flight incidents and one death will occur. Modern commercial aircraft impose certain physical and physiological stresses on passengers, due mainly to the lowered barometric pressure in the cabin during cruising. The top five in-flight incidents are vasovagal, cardiac, pulmonary, and gastrointestinal attacks and minor traumas and burns. Travel by air is, however, safe and can be tolerated by most people. Each aircraft is equipped with emergency oxygen and medical kits, the crew is trained in advanced first aid, and a link to a ground-based medical centre often exists. Ill and elderly people can have their journey specifically prepared for by communication between their physician and the medical service of the particular company, providing the best opportunity for a smooth journey.
Pregnant women and children have special needs and vulnerabilities that should be addressed when preparing for travel abroad. The most stable time for travel during pregnancy is the second trimester. Live vaccines should be avoided during pregnancy. Children should be up to date on both routine and travel-related vaccines. Elective travel to malarious areas, especially where chloroquine-resistant malaria is endemic, should be avoided, as some vaccines and antimalarial drugs may not be used during pregnancy and for children below a certain age. Guidelines on preventive measures are given.