TBI and air travel

My mother is in Central America in hospital with TBI. It is an 18-20 hour trip by air to come home. I would really like some experience or information about air travel, pressure and hematomas since I have received some conflicting information.

She has a reservation, was due to fly next Monday. The hospital seems to be doing things fairly well but the communication is difficult. Doctors talk to nurses who try to talk to my brother who does not speak Spanish and who is allowed to visit for one hour midday when no doctors are available. We have not had an official word re Wed scan yet (Friday). Thank goodness my son-in-law has relatives who work in that hospital! (but don't speak English, so lots of extra telephoning for info to go through).

She is recovering well, walking, talking in two languages, recognizing drugs on her chart from her experience as a transcriptionist, eating. Too bad a doctor has not tried to speak to her directly! She has a skull fracture on one side and hematoma/blood clot on the other. Scans on Monday and then late Wed showed no change in size so not getting bigger. Supposedly 18 on GCS (which internet tells me goes from 3-15..? at least error is on the good side).

Any input re the mechanics of pressure on brain in air travel, guidelines for travel after TBI, etc? We will have to make arrangements with airlines, need some rough ideas re delay. She can stay fairly comfortably in country if needed (resident, about 3-4 hours away from hospital with scanning capability); my brother can't, and we all would prefer she come to me in home town for follow up care....more info than probably needed (stressed!)

[jsinghb]

Hi, did you get a reply or were able to gather additional information on this topic. My father was in an accident in India and suffered a skull fracture. His physical and mental condition is stable but he wants to return to the US later this month (a little over a month following the accident). Just interested in what you heard on the potential risks.
Thanks

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
There will be some amount of increased pressure exerted on the skull in the air cabin. Post head injury accident victims are air lifted too. So travel after head injury is possible. If your father is now stable and there is no chance of hemorrhage, then he can travel. Talk to his doctors. You will need to inform the airlines. Generally head is kept in reclining position, a seat given in the front where the air pressure is minimum, oxygen mask is given as a precautionary measure and if need be a medical doctor accompanies.
If you get a green signal from your father’s doctors, then only plan the air travel and take their advice too regarding what precautions should be taken because they know his case best. Take care!

[caregiver222]

With due respects to Drnee, there should be no increased pressure exerted on the skull in the cabin. Commercial airliners are routinely pressurized to the equivelant of 8,000 ft above sea level, which decreases the oxygen in the cabin by four percent. This results in a slightly increased rate of breathing. Supplemental oxygen should not be necessary.  Most airliners with recent manufacture fleets can have the pressure adjusted to 6,000 ft above sea level, however the airlines are reluctant to do so because the number of pressurization cycles is a factor in aircraft life. If airplanes were routinely pressurized to 6,000 ft above sea level, the fatigue stresses would reduce the airframe life. The new Boeing 787 is designed to be routinely pressurized to 6,000 ft above sea level.  This will result in substantially increased passenger comfort. The first thing to do is to contact the airline you intend to fly and see if they have a flight leaving with the capability of 6,000 ft pressurization, and if they would request the flight engineer to provide such pressurization on the flight you are on. If not, 8,000 foot pressurization should not present any special difficulties.

[caregiver222]

Some modern commercial transport aircraft, such as the Bombardier Global Express XRS, can be safely pressurized (the structures are stronger) on every flight at 4,500 MSL, making them ideal for patient transport.