Moon RE
Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, In.... Date of publication 2014 Mar 1;volume 41(2):159-66.
1. Undersea Hyperb Med. 2014 Mar-Apr;41(2):159-66.
Hyperbaric oxygen treatment for air or gas embolism.
Moon RE.
Gas can enter arteries (arterial gas embolism) due to alveolar-capillary
disruption (caused by pulmonary overpressurization, e.g., breath-hold ascent by
divers) or veins (venous gas embolism, VGE) as a result of tissue bubble
formation due to decompression (diving, altitude exposure) or during certain
surgical procedures where capillary hydrostatic pressure at the incision site is
sub-atmospheric. Both AGE and VGE can be caused by iatrogenic gas injection. AGE
usually produces strokelike manifestations, such as impaired consciousness,
confusion, seizures and focal neurological deficits. Small amounts of VGE are
often tolerated due to filtration by pulmonary capillaries. However, VGE can
cause pulmonary edema, cardiac "vapor lock" and AGE due to transpulmonary passage
or right-to-left shunt through a patent foramen ovale. Intravascular gas can
cause arterial obstruction or endothelial damage and secondary vasospasm and
capillary leak. Vascular gas is frequently not visible with radiographic imaging,
which should not be used to exclude the diagnosis of AGE. Isolated VGE usually
requires no treatment; AGE treatment is similar to decompression sickness (DCS),
with first aid oxygen then hyperbaric oxygen. Although cerebral AGE (CAGE) often
causes intracranial hypertension, animal studies have failed to demonstrate a
benefit of induced hypocapnia. An evidence-based review of adjunctive therapies
is presented.
PMID: 24851554 [Indexed for MEDLINE]
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