Systemic air embolism is a potentially lethal often unrecognised complication of severe chest trauma. We present a case of delayed diagnosis of cerebral air embolism in a patient with severe thoracic trauma. The initiation of positive pressure ventilation, systemic hypotension, intraparenchymal chest drains and aerial transfer to an intensive care unit were all factors contributing to the development of systemic air embolism. The common clinical features, diagnostic tests and management of systemic air emboli are discussed.
SaadaM., GoarinJ-P, RiouB.Systemic gas embolism complicating pulmonary contusion. Diagnosis and management using transesophageal echocardiography.Am J Respir Crit Care Med1995; 152: 812–815.
3.
EnnekingTJMQ, Van der WardenC., De Wall MalifitJ.Bone necrosis of femoral head after thoracic trauma.Injury1994; 25: 122–123.
4.
KingM.W., AitchisonJ.M., NelJ.Fatal air embolism following penetrating lung trauma: an autopsy study.J Trauma1984; 24: 753–755.
5.
MurasI., BonsignoreR., CesaroL., FrascadoreL., BerniniF.P.Post-traumatic cerebral air embolism. Case report.J Neuroradiol1994; 21: 267–269.
6.
HillA.B., FleiszerD.M., BrownR.A.Chest Trauma in a Canadian urban setting - Implications for trauma research in Canada.J Trauma1991; 31: 971–973.
7.
TrunkeyD.Initial treatment of patients with extensive trauma.N Eng J Med1991; 324: 1259–1263.
8.
SteneJ.K., GrandeC.M., BernhardW.N., BartonC.J.Peri-operative anesthetic management of the trauma patient: thoracoabdominal and orthopaedic injuries. In: Stene JK, Grande CM, eds. Trauma Anesthesia.Williams & Wilkins, Baltimore1991; 219.
9.
ThackaryN.N., MurphyP.M., McLeanR.F., DelacyJ.L.Venous air embolism accompanied by echocardiographic evidence of transpulmonary air passage.Crit Care Med1996; 24: 359–361.
10.
HagenP.T., SchultzD.G., EdwardsW.D.Incidents and size of patent foramen ovale during the first ten decades of life: an autopsy study of 965 normal hearts.Mayo Clin Proc1984; 59: 17–20.
DuborgO., BourdariasJ.P., FarcotJ.C., GueretP., TerdgmanM., FarrierA., RigaudM., BardetJ.C.Contrast echocardiographic visualisation of cough-induced right-to-left shunt through a patent foramen ovale.J Am Coll Cardiol1984; 4: 587–594.
13.
UlyattD.B., JudsonJ., TrubuhovichR.V., GallerL.H.Cerebral arterial air embolism associated with coughing on a continuous positive airway pressure circuit.Crit Care Med1991; 19: 985–987.
14.
MichaelL., PoskanzerD.C., McKusickK.A., NardiG.L., MaltR.A.Fatal paradoxical air embolism to the brain. Complications of central venous catheterization.JPEN1982; 6: 68–70.
15.
SinnerW.N.Complications of percutaneous transthoracic needle biopsy.Acta Radiol Diagn1976; 17: 813–828.
16.
GoldfarbB., BahnsonH.T.Early and late effects on the heart of small amounts of air in the coronary circulation.J Thorac Cardiovasc Surg1980; 80: 708–717.
17.
BakerC.C., ThomasA.N., TrunkeyD.D.The role of emergency room thoracotomy in trauma.J Trauma1990; 20: 848–855.
18.
SwansonJ., TrunkeyD.D.Trauma to chest wall, pleura, and thoracic viscera, In: Shields TW, ed. General Thoracic Surgery, 3rd Ed.Lea & Febiger, Philadelphia1989; 463.
19.
MariniJ.J., CulverB.H.Systemic gas embolism complicating mechanical ventilation in the adult respiratory distress syndrome.Ann Intern Med1989; 110: 699–703.
20.
KindwallE.P.Uses of hyperbaric oxygen therapy in the 1990s.Cleve Clin J Med1992; 59: 517–528
21.
ThomasA.N., StephensB.G.Air embolism: A cause of morbidity and death after penetrating chest trauma.J Trauma1974; 14: 633–638.
22.
HirabukiB.N., MiuraT., MitomoM.Changes of cerebral air embolism shown by computerized tomography.Br J Radiol1988; 61: 252–255.
23.
JensernM.E., LippeM.H.CT in iatrogenic cerebral air embolism.Am J Neuroradiol1986; 7: 823–827.
24.
OxornD., EdelistG., SmithM.S.An introduction to trans-esophageal echocardiography: II. Clinical applications.Can J Anaesth1996; 43: 278–294.
25.
JohnsonS.B., KearneyP.A., SmithN.W.Echocardiography in the evaluation of thoracic trauma.Surg Clin North Am1995; 75: 193–205.
26.
Van der LindenJ., Casimir-AnhH.When do cerebral emboli appear during open heart operations? A transcranial Doppler study.Ann Thorac Surg1991; 51: 237–241.
27.
RankinN., DayA.C., CroneP.D.Traumatic massive air leak treated with prolonged double lumen intubation and high frequency ventilation: case report.J Trauma1994; 36: 428–429.
28.
HalpernP., GreensteinA., MelamedY., TaitelmanU., SznajderI., ZveibilF.Arterial air embolism after penetrating lung injury.Crit Care Med1983; 11: 392–393.
SadanO., AdlerM., EzraS., ZakutH.Air embolism due to pulmonary barotrauma in a patient undergoing cesarean section.Acta Obstet Gynecol Scand1991; 70: 551–553.
31.
BittermanH., MelamedY.Delayed hyperbaric treatment of cerebral air embolism.Israel J Med Sci1993; 29: 22–26.
32.
DiakunT.A.Carbon dioxide embolism: Successful resuscitation with cardiopulmonary bypass.Anesthesiology1991; 74: 1151–1153.
