Hemodynamic Consequences of PEEP in Seated Neurological Patients-Implications for Paradoxical Air Embolism

Perkins, Nancy A.; Bedford, Robert F.

doi:10.1213/00000539-198404000-00009

Cited by 62 publications

(17 citation statements)

References 21 publications

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“…Данное положение за счет повыше-ния давления в правом предсердии также позво-ляет снизить риск ВВЭ. Это не единственная пу-бликация, где за счет подъема нижних конечно-стей, форсированной инфузионной терапии кол-лоидными растворами и других хитростей авторы пытаются избежать отрицательного внутрисинус-ного давления [30]. В одной из таких работ вообще предлагалось надевать на больных специальные пневмокомпрессионные штаны («military anti shock trousers»), которые при инфляции выдавли-вают депонированную кровь из сосудов нижних конечностей [31].…”

Section: Discussionunclassified

Paradoxical air embolism resulted in acute myocardial infarction and massive ischemic brain injury in a patient operated on in a sitting position

et al. 2016

Vopr. neirokhir.

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Section: Discussionunclassified

Paradoxical air embolism resulted in acute myocardial infarction and massive ischemic brain injury in a patient operated on in a sitting position

et al. 2016

Vopr. neirokhir.

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“…After tracheal intubation, mechanical ventilation was performed in continuous mandatory ventilation mode with parameters providing a constant concentration of end-expired carbon dioxide (etCO 2 ) at a level of 40 mmHg. Positive end-expirotary pressure (PEEP) was not used due to its possible negative effect on hemodynamics, low efficacy for the prevention of VAE and increased likelihood of PAE during the development of VAE [14,15]. After induction a peripheral catheter 16-18G was inserted into one of the veins of the leg or foot to provide additional vascular access.…”

Section: Methodsmentioning

confidence: 99%

The impact of transesophageal echocardiography based protocol for management of adults in the sitting position on the incidence of clinically significant venous air embolism

et al. 2020

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The purpose of the study was to evaluate the impact of transesophageal echocardiography (TEE) – based protocol for management of adults in the sitting position during elective neurosurgical interventions on the incidence of clinically significant venous air embolism (VAE). Material and Methods ― The study involved 155 adult neurosurgery patients (70 in prospective group and 85 in retrospective group). Surgery in both groups was done in the sitting position. In the prospective group TEE-based protocol was used. Retrospective group served as control. The primary endpoint was considered to be a decrease in the frequency of clinically significant VAE in the prospective group in comparison with the retrospective one. In the prospective group, VAE with Tuebingen grade 3-5 was considered clinically significant. The PFO incidence and severity and the effect of the number of episodes of VAE per case on its maximum severity during surgery were also analyzed. Any complication in the postoperative period believed to be associated with the position of the patient on the table during the surgery was recorded. Results ― The incidence of the clinically significant VAE in the retrospective group was 23.5% (95% CI 15-34) and was 16.4% higher than the frequency in the prospective group (chi-square=7.6197, df=1, p=0.005). 50% (95% CI 38-62) of patients in prospective group developed VAE during surgery. In 16 cases, the number of episodes was more than one. The number of episodes of VAE in the observation was reliably associated with the maximum severity of VAE during the observation (Z=4.11; p<0.001). A moderate strength relationship was determined between them (SomersDelta=0.43; 95% CI 0.17-0.7). Not a single case of paradoxical air embolism was detected in a series of observations. None of the patients has got a neurological deficit or cardiopulmonary complications associated with the position on the surgical table in the postoperative period. Pneumocephalus was found in 100% of cases on head computed tomography, which, however, did not need surgical treatment. PFO in the prospective group was detected in 62% (95% CI 52-73) of patients. In 25% (95% CI 16-35), shunting was significant. A large PFO without Valsalva maneuver was detected in 12.5% (95% CI 6-21) of cases. Conclusion ― The use of the TEE-based protocol for the management of adult patients in a sitting position during elective neurosurgical interventions can reduce the incidence of clinically significant VAE.

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“…Die Indikationen für die neurochirurgischen Eingriffe waren Tumoren der hinteren Schädelgrube bei 103 Patienten (62%), Diskusprolapse bei 25 Patienten (15%), intrakranielle Aneurysmen oder AV-Malformationen bei 16 Patienten (10%) oder Ein offenes Foramen ovale (PFO) liegt in Abhängigkeit vom Alter in 25-30% der Bevölkerung vor [13,29]. Für Patienten, die einer neurochirurgischen Intervention in sitzender Position unterzogen werden, stellt ein PFO durch die potentielle Gefahr einer paradoxen Luftembolie ein besonderes Risiko dar [2,3,9,11,12,15,[21][22][23][24] The detection or ruling out of a patent foramen ovale (PFO) can be determined noninvasively by contrast echocardiography (CE).The transesophageal technique is superior to the transthoracic technique regarding sensitivity, whereas the specificity of both methods is equally high.This prospective study shows the rational use of transesophageal CE for the detection of a PFO, in patients without cardiovascular disorders. bei jüngeren Patienten mit Zustand nach zentralen oder peripheren embolischen Ereignissen zunehmend an Bedeutung [1,5,6,8,14,17,25].…”

Section: Methodikunclassified

Präoperative Diagnostik eines offenen Foramen ovale

Weihs¹,

Schuchlenz²,

Harb³

et al. 1998

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Hemodynamic Consequences of PEEP in Seated Neurological Patients-Implications for Paradoxical Air Embolism

Cited by 62 publications

References 21 publications

Paradoxical air embolism resulted in acute myocardial infarction and massive ischemic brain injury in a patient operated on in a sitting position

Paradoxical air embolism resulted in acute myocardial infarction and massive ischemic brain injury in a patient operated on in a sitting position

The impact of transesophageal echocardiography based protocol for management of adults in the sitting position on the incidence of clinically significant venous air embolism

Präoperative Diagnostik eines offenen Foramen ovale

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