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      Embolismo gaseoso masivo yatrogénico tratado con oxigenoterapia hiperbárica Translated title: Iatrogenic massive gas embolism treated with hyperbaric oxygen therapy

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          Abstract

          RESUMEN El embolismo aéreo se caracteriza por la presencia de gas en el torrente circulatorio. Puede producirse por la práctica del buceo y como complicación de distintos procedimientos diagnósticos y/o terapeúticos. En algunos casos tiene graves complicaciones médicas, incluida la muerte. La repercusión clínica depende del volumen de aire dentro del sistema cardiovascular de la velocidad de entrada del aire y de su localización. En los casos más graves el diagnóstico y su tratamiento debe ser inmediato. La oxigenoterapia hiperbárica permite realizar un tratamiento etiológico inmediato mediante la rápida disminución del tamaño de las burbujas de aire y su disolución.

          Translated abstract

          SUMMARY Air embolism is characterized by the presence of gas in the bloodstream. It can be caused by diving and as a complication of different diagnostic and / or therapeutic procedures. In some cases it has serious medical complications, including death. The clinical impact depends on the volume of air within the cardiovascular system, the air intake velocity and its location. In the most serious cases, diagnosis and treatment must be immediate. Hyperbaric oxygen therapy allows immediate etiological treatment by rapidly reducing the size of air bubbles and dissolving them.

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          Iatrogenic cerebral air embolism: importance of an early hyperbaric oxygenation.

          To assess the relationship between the time period before hyperbaric oxygenation therapy (HBO) and clinical outcome in patients with iatrogenic cerebral air embolism. Retrospective study in a hyperbaric chamber and medical intensive care unit of a university hospital. All patients with air embolism from 1980 to 1999. We retrieved the cases of 86 patients who benefited from an identical HBO and analyzed the relationship between the time period before HBO and clinical outcome. Patients treated with HBO less than 6 h had a better outcome than those treated later. In patients treated within this delay the cause was venous air embolism in 84% and arterial air embolism in only 16% of cases. After this delay the cause was venous air embolism (53%) and arterial air embolism (47%). Patients with venous air embolism and recovery had a shorter delay than patients with sequelae or death (2 h 15 min vs. 4 h). Patients with venous air embolism treated less than 6 h had a better outcome than those treated later. In patients with arterial air embolism the time period before HBO was longer than in venous air embolism (8 h vs. 3 h) and the outcome worse (recovery in 35% vs. 67%). In patients with arterial air embolism no difference in the time period was found between patients with recovery and sequelae or death. We stress the beneficial effect of an early HBO in air embolism, the importance of an increased awareness of physicians concerned with this severe complication, and the need to develop techniques to detect air emboli in the cerebral circulation.
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            Air Embolism: Practical Tips for Prevention and Treatment

            Air embolism is a rarely encountered but much dreaded complication of surgical procedures that can cause serious harm, including death. Cases that involve the use of endovascular techniques have a higher risk of air embolism; therefore, a heightened awareness of this complication is warranted. In particular, central venous catheters and arterial catheters that are often placed and removed in most hospitals by a variety of medical practitioners are at especially high risk for air embolism. With appropriate precautions and techniques it can be preventable. This article reviews the causes of air embolism, clinical management and prevention techniques.
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              Acute management of vascular air embolism

              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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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                June 2021
                : 77
                : 2
                : 94-97
                Affiliations
                [4] orgnameHospital Central de la Defensa Gómez Ulla
                [5] orgnameHospital Central de la Defensa Gómez Ulla
                [2] orgnameHospital Central de la Defensa Gómez Ulla
                [1] orgnameHospital Central de la Defensa Gómez Ulla
                [3] orgnameHospital Central de la Defensa Gómez Ulla
                Article
                S1887-85712021000200094 S1887-8571(21)07700200094
                10.4321/s1887-85712021000200005
                89e6f992-80b6-45a0-bd0b-4663c9b7a752

                http://creativecommons.org/licenses/by/4.0/

                History
                : 16 December 2020
                : 14 April 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 4
                Product

                SciELO Spain

                Categories
                Informe

                aeroembolismo,oxígeno hiperbárico,yatrogenia,angioTC,Air embolism,hyperbaric oxygen,iatrogenic

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