Paradoxical Air Embolism Successfully Treated With Hyperbaric Oxygen

Abstract

The use of the central venous catheter may be complicated by air embolism when central venous pressure is subatmospheric and the catheter is open to the surrounding air. Paradoxical air embolus occurs when the gas bubbles are able to traverse a right to left shunt, gaining access to the systemic arterial circulation causing ischemic symptoms in end organs. In this article, a case of a patient with an unknown patent foramen ovale through which air entered the arterial circulation resulting in obtundation and stroke after inadvertent manipulation of a Hickman catheter is presented. The physiology, clinical manifestations, and management strategies are also discussed.

Systemic Air Embolism Associated with Pleural Pigtail Chest Tube Insertion

“…If cerebral air embolism is suspected, the patient must start on high-flow oxygen therapy to increase tissue oxygenation, which helps in reducing the embolic volume by eliminating nitrogen [14]. When suspecting venous air embolization, the patient must be placed into the left lateral decubitus position with the head down or in Trendelenburg position in order to prevent air from entering the systemic arterial circulation by remaining in the superior aspect of the left ventricle and, away from the aorta [2, 15].…”

Cholecystectomy in the presence of a large patent foramen ovale: laparoscopic or open?

“…However, it is not 100% efficient in detecting emboli, and when emboli have been detected, it is after they have passed into the arterial system [23]. A recent report described successful treatment of a paradoxical air embolus with hyperbaric oxygen [16], suggesting that this modality be available when TEE monitoring is used. In a prospective TEE study of 16 ASA physical status I patients undergoing laparoscopic cholecystectomy, CO 2 emboli were seen in 11 of those patients [5].…”

“…After emergence from anesthesia, clinical abnormalities attributable to CO 2 embolus or bubble detection by sonogram or computed tomography (CT) would be managed with immediate postoperative transfer to a nearby hospital with a hyperbaric chamber used to treat gas emboli [16]. The interventional neuroangiography team was also consulted, and they agreed to provide immediate assistance in the event that cerebral angiograms were needed.…”

Man with Altered Mentation after Trauma

“…While rare, retrospective studies demonstrate mortality up to 23% and recent prospective literature demonstrates a 1-year mortality of 21%. Morbidity is higher 1–5. Iatrogenic air emboli can be either arterial or venous.…”

“…Iatrogenic air emboli can be either arterial or venous. Arterial gas emboli (AGE) can manifest as chest pain, transient ischemic attack, stroke, or shock 3,5–7. While most are asymptomatic, venous gas emboli (VGE) more commonly present as shortness of breath 5, 6…”