Cerebral arterial air embolism associated with coughing on a continuous positive airway pressure circuit

Ulyatt, D. B.; Judson, James A.; Trubuhovich, Ronald V; Galler, L

doi:10.1097/00003246-199107000-00029

Cited by 21 publications

(11 citation statements)

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“…These events happened over a damaged lung either by an inflammatory process, or, in the case reported by Hung and colleagues,7 the patient presented with barotraumatism following bilevel ventilation with a face mask for a post-transplant pneumonitis. In the case described by Ulyatt and colleagues,8 the air embolism was associated with heavy coughing on a continuous positive airway pressure circuit, which is a situation very similar to the one encountered by our patient.…”

Section: Discussionsupporting

confidence: 83%

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Fatal brain gas embolism during non-invasive positive pressure ventilation

Rivara¹,

Chevrolet²,

Gasche³

et al. 2008

Case Reports

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Gas embolism is a dreaded complication following invasive medical procedures, traumatic lung injury and decompression accidents. We report a case of fatal gas embolism following the use of non-invasive ventilation (NIV) with bilevel positive airway pressure (BiPAP). The patient initially underwent left bronchial artery embolisation for massive haemoptysis in the context of severe tuberculotic sequels. Under NIV and after heavy coughing he became hemiparetic and his level of consciousness suddenly dropped. Computed tomography of the brain showed multiple air embolism and ischaemic lesions were confirmed by magnetic resonance imaging. Echocardiographic investigations showed no intracardiac defect. Vasculo-pulmonary abnormalities in the context of heavy coughing and non-invasive ventilation may have played a major role in the occurrence of this event. New neurological events in a patient with tuberculotic sequels or any known vascular pulmonary abnormalities and NIV should raise the suspicion of brain gas embolism.

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Section: Discussionsupporting

confidence: 83%

“…To the best of our knowledge, over the past 20 years, only two similar cases of gas embolism related to non-invasive ventilation (NIV) in non-critically ill patients have been described 7 , 8…”

Section: Introductionmentioning

confidence: 99%

Fatal brain gas embolism during non-invasive positive pressure ventilation

Rivara¹,

Chevrolet²,

Gasche³

et al. 2008

Case Reports

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“…[6] Approximately, 7% of penetrating chest trauma patient will have VAE. [7] Few case reports of VAE after barotraumas[8] and use of pressure infuser bag. [9] In scuba (self contained underwater breathing apparatus) divers air embolism is second common fatal cause, the incidence are 7/100,000 dives.…”

Section: Epidemiologymentioning

confidence: 99%

Acute management of vascular air embolism

Shaikh

Ummunisa

2009

J Emerg Trauma Shock

123

108

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Vascular air embolism (VAE) is known since early nineteenth century. It is the entrainment of air or gas from operative field or other communications into the venous or arterial vasculature. Exact incidence of VAE is difficult to estimate. High risk surgeries for VAE are sitting position and posterior fossa neurosurgeries, cesarean section, laparoscopic, orthopedic, surgeries invasive procedures, pulmonary overpressure syndrome, and decompression syndrome. Risk factors for VAE are operative site 5 cm above the heart, creation of pressure gradient which will facilitate entry of air into the circulation, orogenital sex during pregnancy, rapid ascent in scuba (self contained underwater breathing apparatus) divers and barotrauma or chest trauma. Large bolus of air can lead to right ventricular air lock and immediate fatality. In up to 35% patient, the foramen ovale is patent which can cause paradoxical arterial air embolism. VAE affects cardiovascular, pulmonary and central nervous system. High index of clinical suspicion is must to diagnose VAE. The transesophgeal echocardiography is the most sensitive device which will detect smallest amount of air in the circulation. Treatment of VAE is to prevent further entrainment of air, reduce the volume of air entrained and haemodynamic support. Mortality of VAE ranges from 48 to 80%. VAE can be prevented significantly by proper positioning during surgery, optimal hydration, avoiding use of nitrous oxide, meticulous care during insertion, removal of central venous catheter, proper guidance, and training of scuba divers.

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“…However, while there are few reports of adverse events in the literature, they relate to barotrauma [75] and loss of airway protection [76]. The use of CPAP in hypercapnia and/or hypoventilation may be inappropriate as tidal volume and minute ventilation are uncontrolled [74].…”

Section: Precautions With Continuous Positive Airway Pressure Treatmentmentioning

confidence: 99%

The use of positive pressure devices by physiotherapists

Denehy

Berney²

2001

Eur Respir J

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The aim of this paper is to review the indications for use by physiotherapists, such as physiological rationale and the comparative efficacy of intermittent positive pressure breathing (IPPB) and continuous positive airway pressure (CPAP). A brief discussion of nasal intermittent positive airway pressure is also included.The use of IPPB for post operative prophylaxis has not been supported in the literature. In patients with low lung volumes resulting from neuromuscular disease or spinal injury, IPPB may be useful in the acute phase to improve tidal volume and cough effectiveness.The physiological benefits of CPAP to improve lung volumes are well documented in the literature. Physiotherapists use CPAP as an intermittent application in patients with low lung volumes following surgery. It is predominantly used as a second line intervention in the presence of refractory atelectasis and poor gas exchange. It may also be indicated in other patient groups with similar physiological problems.Nasal intermittent positive airway pressure combines the beneficial effects of intermittent positive pressure breathing and continuous positive airway pressure. There have been many studies evaluating its effectiveness. These have been supportive for patients with neuromuscular disease and sleep disordered breathing, but more research is needed in patients with acute respiratory failure.

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Cerebral arterial air embolism associated with coughing on a continuous positive airway pressure circuit

Cited by 21 publications

References 0 publications

Fatal brain gas embolism during non-invasive positive pressure ventilation

Fatal brain gas embolism during non-invasive positive pressure ventilation

Acute management of vascular air embolism

The use of positive pressure devices by physiotherapists

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