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He YP, Liu YL, Gao XL, Wang LH. Cerebral arterial air embolism after endobronchial electrocautery: a case report and review of the literature. BMC Pulm Med 2021; 21:222. [PMID: 34247608 PMCID: PMC8274011 DOI: 10.1186/s12890-021-01580-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Endobronchial electrocautery is a common and safe therapeutic endoscopic treatment for malignant airway obstruction. Cerebral arterial air embolism (CAAE) is a rare but potentially fatal complication of endobronchial electrocautery. Case presentation We present the first case of cerebral arterial air embolism after endobronchial electrocautery. A 56-year-old male with a pulmonary tumour in the right upper lobe received repeated endobronchial electrocautery. During the procedure, he experienced unresponsiveness, hypoxemia and bradycardia, and he developed tetraplegia. Brain computed tomography showed several cerebral arterial air emboli with low-density spots in the right frontal lobe. He received hyperbaric oxygen therapy with almost full recovery, except for residual left-sided weakness. Conclusions General physicians should realize that CAAE may be a possible complication of endobronchial electrocautery. Several measures, including avoiding positive pressure, lowering ventilatory pressures if possible, avoiding advancing the bronchoscope to occlude the bronchus and using the non-contact technique, should be used to prevent this devastating complication.
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Affiliation(s)
- Yu-Ping He
- Department of Pulmonary and Critical Care Medicine, Yunfu People's Hospital, Huanshi Dong Lu No.120, Yuncheng DistrictYunfu, 527300, China
| | - Yuan-Ling Liu
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Xing-Lin Gao
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Li-Hua Wang
- Department of Pulmonary and Critical Care Medicine, Yunfu People's Hospital, Huanshi Dong Lu No.120, Yuncheng DistrictYunfu, 527300, China.
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Kalsi HS, Thakrar R, Gosling AF, Shaefi S, Navani N. Interventional Pulmonology: A Brave New World. Thorac Surg Clin 2020; 30:321-338. [PMID: 32593365 DOI: 10.1016/j.thorsurg.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Interventional pulmonology is a dynamic and evolving field in respiratory medicine. Advances have improved the ability to diagnose and manage diseases of the airways. A shift toward early detection of malignant disease has generated a focus on innovative diagnostic techniques. With patient populations living longer with malignant and benign diseases, the role for interventional bronchoscopy has grown. In cancer groups, novel immunotherapies have improved the prospects of clinical outcomes and reignited a focus on optimizing patient performance status to enable access to anticancer therapy. This review discusses current and emerging diagnostic modalities and therapeutic approaches available to manage airway diseases.
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Affiliation(s)
- Hardeep S Kalsi
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Ricky Thakrar
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Andre F Gosling
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Neal Navani
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK.
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Mahajan AK, Ibrahim O, Perez R, Oberg CL, Majid A, Folch E. Electrosurgical and Laser Therapy Tools for the Treatment of Malignant Central Airway Obstructions. Chest 2019; 157:446-453. [PMID: 31472155 DOI: 10.1016/j.chest.2019.08.1919] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 07/13/2019] [Accepted: 08/11/2019] [Indexed: 01/25/2023] Open
Abstract
Central airway obstruction (CAO) is associated with significant morbidity and increased mortality. Bronchoscopic electrosurgical and laser ablative tools have proven to be safe and effective instruments for the treatment of malignant CAO. Although therapeutic modalities such as electrocautery, argon plasma coagulation, and laser have been used for decades, additional tools including radiofrequency ablation catheters continue to be developed for the treatment of CAO. These modalities are considered safe in the hands of experienced operators, although serious complications can occur. This review describes various electrosurgical and laser therapy tools used for the treatment of malignant CAO along with the specific advantages and disadvantages of each device.
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Affiliation(s)
- Amit K Mahajan
- Interventional Pulmonology and Complex Airways Disease Program, Division of Thoracic Surgery and Interventional Pulmonology, Inova Fairfax Medical Center, Falls Church, VA.
| | - Omar Ibrahim
- Division of Pulmonary and Critical Care Medicine, University of Connecticut Medical School, Hartford, CT
| | - Ricardo Perez
- Division of Pulmonary and Critical Care Medicine, University of Connecticut Medical School, Hartford, CT
| | - Catherine L Oberg
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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4
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Shepherd RW, Radchenko C. Bronchoscopic ablation techniques in the management of lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:362. [PMID: 31516908 DOI: 10.21037/atm.2019.04.47] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Central airway involvement is a common manifestation of lung cancer during the disease course. Some patients will require bronchoscopic therapeutic interventions to palliate symptoms, or less commonly to provide more definitive therapy of airway involvement. We describe an overview specifically of bronchoscopic ablative techniques that are available for use in malignant airway obstruction. Techniques that are more commonly used include bronchoscopic application of laser, electrocautery, argon plasma coagulation (APC), cryotherapy and mechanical debulking techniques. Less commonly employed are brachytherapy and photodynamic therapy. These techniques may be applied via flexible or rigid bronchoscopy depending upon the clinical scenario. The choice of technique depends on available tools and expertise, the urgency of the clinical scenario, and whether the lesion is predominately endobronchial, extrinsic compression, or a combination of both. Malignant airway obstruction is a common finding in lung cancer and there are a number of effective bronchoscopic ablative techniques that may be employed safely to palliate patients with a significant symptom burden.
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Affiliation(s)
- Ray W Shepherd
- Division of Pulmonary and Critical Care, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Christopher Radchenko
- Division of Pulmonary and Critical Care, University of Cincinnati Health System, Cincinnati, OH, USA
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Abstract
This review comprehensively describes recent advances in the management of malignant central airway obstruction (CAO). Malignant CAO can be a dramatic and devastating manifestation of primary lung cancer or metastatic disease. A variety of diagnostic modalities are available to provide valuable information to plan a therapeutic intervention. Clinical heterogeneity in the presentation of malignant CAO provides opportunities to adapt and utilize endoscopic technology and tools in many ways. Mechanical debulking, thermal tools, cryotherapy and airway stents are methods and instruments used to rapidly restore airway patency. Delayed bronchoscopic methods, such as photodynamic therapy (PDT) and brachytherapy can also be utilized in specific non-emergent situations to establish airway patency. Although data regarding the success and complications of therapeutic interventions are retrospective and characterized by clinical and outcome measure variability, the symptoms of malignant CAO can often be successfully palliated. Assessment of risks and benefits of interventions in each individual patient during the decision-making process forms the critical foundation of the management of malignant CAO.
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Affiliation(s)
- Lakshmi Mudambi
- Division of Pulmonary, VA Portland Health Care System, Oregon Health & Science University, Portland, OR, USA
| | - Russell Miller
- Division of Pulmonary, Interventional Pulmonology, Naval Medical Center, San Diego, CA, USA
| | - George A Eapen
- Division of Interventional Pulmonology, University of Texas-MD Anderson Cancer Center, Houston, TX, USA
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6
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Mao Y, Yang X, Li M, Guo W, Zhang W. Treating cancerous large airway stenosis with staging radioactive particle implantation guided by computed tomography and fiber bronchoscopy: a clinical study. World J Surg Oncol 2017; 15:149. [PMID: 28774331 PMCID: PMC5543595 DOI: 10.1186/s12957-017-1216-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 07/25/2017] [Indexed: 01/19/2023] Open
Abstract
Background The purpose of this study is to investigate the clinical effectiveness of staging radioactive particle implantation guided by computed tomography (CT) and fiber–optic bronchoscopy in treating cancerous large airway stenosis. Methods A total of 102 patients were included; 57 had undergone staging radioactive particle implantation guided by CT and fiber bronchoscopy and 45 did not. Patients were evaluated by CT and fiber–optic bronchoscopy to determine the feasibility of the implantation of radioactive seeds for the treatment of cancerous large airway stenosis. The treatment planning system (TPS) was used to plan the doses. Radioactive seeds were implanted using fiber–optic bronchoscopy. One week later, CT-guided implantation of radioactive seeds was performed. Results The clinical evaluation showed complete, partial, slight, and non-response in 38, 14, 5, and 0 patients, respectively. None of the patients were found with serious complications. The diameter of the affected airway, Karnofsky score, dyspnea index, survival, and quality of life of the patients in both groups was significantly higher and significantly different after the treatment (P < 0.05). The dyspnea index was significantly lower in the treatment group as compared with the control group (P < 0.001). Conclusion CT- and fiber bronchoscopy-guided staging radioactive particle implantation has definite treatment effectiveness in treating cancerous large airway stenosis. It should be widely used in clinical practices.
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Affiliation(s)
- Yu Mao
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China.
| | - Xiuyan Yang
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China
| | - Ming Li
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China
| | - Wei Guo
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China
| | - Wenhua Zhang
- Department of Thoracic Surgery, The First People's Hospital of Hohhot, Hohhot, Inner Mongolia, 010020, China
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Kanchustambham V, Reddy M, Saladi S, Patolia S. Cerebral Air Embolism as Possible Cause of Stroke During Therapeutic Endobronchial Application of Argon Plasma Coagulation. Cureus 2017. [PMID: 28649478 PMCID: PMC5473730 DOI: 10.7759/cureus.1255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 68-year-old male was admitted for evaluation of an endobronchial mass obstructing the right middle lobe (RML) and right lower lobe (RLL) of the lung. Flexible bronchoscopy revealed a notable endobronchial lesion in the bronchus intermedius that completely obstructed the RML and the RLL. Argon plasma coagulation (APC) at 30 watts and gas flow at 0.8 liters/minute to 1 liter/minute were applied to the tumor. In the recovery room, the patient was discovered to have a left-sided facial droop and left-sided weakness. The initial computed tomography (CT) scan of the brain and an angiogram of the head and neck were normal, but a repeat CT scan of the head several hours later was remarkable for an area of hypoattenuation in the right frontoparietal lobe concerning for infarct. A magnetic resonance imaging (MRI) brain scan confirmed acute to sub-acute cortical infarcts. Given the direct temporal relation between the onset of neurologic symptoms and the usage of APC with bronchoscopy, a cerebral air embolism (CAE) was thought to be the cause of the patient's acute stroke.
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Affiliation(s)
| | - Manasa Reddy
- General Internal Medicine, Saint Louis University School of Medicine
| | - Swetha Saladi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine
| | - Setu Patolia
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine
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8
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Kanchustambham V, Saladi S, Mehta K, Mwangi J, Jamkhana Z, Patolia S. Vascular Air Embolism During Bronchoscopy Procedures- Incidence, Pathophysiology, Diagnosis, Management and Outcomes. Cureus 2017; 9:e1087. [PMID: 28405537 PMCID: PMC5384844 DOI: 10.7759/cureus.1087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/09/2017] [Indexed: 12/19/2022] Open
Abstract
Vascular air embolism (VAE) is a rare, but potentially fatal complication of invasive medical or surgical procedures. It is a very rare complication of bronchoscopy and is most frequently reported with therapeutic bronchoscopy with Argon plasma coagulation (APC) or neodymium-doped yttrium aluminum garnet (Nd-YAG) laser. Despite being rare, as a result of its high chance of mortality and morbidity, it is imperative that physicians have high clinical suspicion to allow for early recognition and treatment. In this article, we provide a concise review of the incidence, pathophysiology, diagnosis management and outcomes of air embolism during bronchoscopy procedures.
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Affiliation(s)
| | - Swetha Saladi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine
| | - Kris Mehta
- Internal Medicine, Saint Louis University School of Medicine
| | - John Mwangi
- Pulmonary and Critical Care Medicine , Saint Louis University School of Medicine
| | - Zafar Jamkhana
- Pulmonary and Critical Care Medicine , Saint Louis University School of Medicine
| | - Setu Patolia
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine
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Lin CY, Chung FT. Central airway tumors: interventional bronchoscopy in diagnosis and management. J Thorac Dis 2016; 8:E1168-E1176. [PMID: 27867582 DOI: 10.21037/jtd.2016.10.101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The diagnosis of central airway tumors is usually challenging because of the vague presentations. Advances in visualization technology in bronchoscopy aid early detection of bronchial lesion. Cryotechnology has great impact on endobronchial lesion sampling and provides better diagnostic yield. Airway tumor involvements result in significant alteration in life quality and lead to poor life expectancy. Timely and efficiently use ablation techniques by heat or cold energy provide symptoms relief for central airway obstruction. Prostheses implantation is effective in maintaining airway patency after ablative procedure or external compression. Combined interventional bronchoscopy modalities and other adjunctive therapies have improvement in quality of life and further benefit in survival. This review aims to provide a diagnostic approach to central airway tumors and an overview of currently available techniques of interventional bronchoscopy in managing symptomatic central airway obstruction.
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Affiliation(s)
- Chun-Yu Lin
- Department of Thoracic Medicine, Saint Paul's Hospital, Taoyuan, Taiwan; ; Department of General Medicine & Geriatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; ; College of Medicine Chang Gung University, Taoyuan, Taiwan
| | - Fu-Tsai Chung
- Department of Thoracic Medicine, Saint Paul's Hospital, Taoyuan, Taiwan; ; College of Medicine Chang Gung University, Taoyuan, Taiwan; ; Department of Thoracic Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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10
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Sachdeva A, Pickering EM, Lee HJ. From electrocautery, balloon dilatation, neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser to argon plasma coagulation and cryotherapy. J Thorac Dis 2016; 7:S363-79. [PMID: 26807284 DOI: 10.3978/j.issn.2072-1439.2015.12.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Over the past decade, there has been significant advancement in the development/application of therapeutics in thoracic diseases. Ablation methods using heat or cold energy in the airway is safe and effective for treating complex airway disorders including malignant and non-malignant central airway obstruction (CAO) without limiting the impact of future definitive therapy. Timely and efficient use of endobronchial ablative therapies combined with mechanical debridement or stent placement results in immediate relief of dyspnea for CAO. Therapeutic modalities reviewed in this article including electrocautery, balloon dilation (BD), neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser, argon plasma coagulation (APC), and cryotherapy are often combined to achieve the desired results. This review aims to provide a clinically oriented review of these technologies in the modern era of interventional pulmonology (IP).
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Affiliation(s)
- Ashutosh Sachdeva
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Edward M Pickering
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Hans J Lee
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
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11
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Usefulness of Rigid Bronchoscopic Intervention Using Argon Plasma Coagulation for Central Airway Tumors. Clin Exp Otorhinolaryngol 2015; 8:396-401. [PMID: 26622961 PMCID: PMC4661258 DOI: 10.3342/ceo.2015.8.4.396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/17/2014] [Accepted: 08/08/2014] [Indexed: 12/05/2022] Open
Abstract
Objectives Argon plasma coagulation (APC) is a noncontact form of electrocautery that utilizes ionized argon as the electrical current. A rigid bronchoscopic use of APC for the management of central airway obstruction could be safe and rapidly effective. This study evaluated the usefulness of rigid bronchoscopy with APC for the management of central airway obstructions due to benign or malignant tumors. Methods Twenty patients with obstructing central airway tumors were retrospectively reviewed from February 2008 to February 2013 at Chonnam National University Hospital. All patients received rigid bronchoscopic tumor removal under general anesthesia. APC was applied before and after tumor removal. Results The median age of patients was 59 years (interquartile range [IQR], 51 to 67 years) and 70% were female. The causes of airway obstruction included malignancy (n=8) and benign tumor (n=12). Airway tumors comprised intraluminal lesions (n=11, 55%) and mixed intraluminal/extraluminal lesions (n=9, 45%). The median tumor size was 15 mm (IQR, 10 to 18 mm). The median degree of airway obstruction was significantly reduced after intervention (90% [IQR, 88% to 96%] vs. 10% [IQR, 0% to 20%], P<0.001). The median American Thoracic Society dyspnea grade (3 [IQR, 1 to 4] vs. 1 [IQR, 0 to 1], P<0.001) and forced expiratory volume in one second (1.03 L [IQR, 0.52 to 1.36 L] vs. 1.98 L [IQR, 1.57 to 2.64 L], P=0.004) were significantly improved after intervention. There were no procedure-related acute complications and deaths. Conclusion Rigid bronchoscopy with APC is an effective and safe procedure to alleviate central airway obstruction caused by tumors.
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Sebat CM, Albertson TE, Morrissey BM. Cerebral gas embolism in a case of Influenza A-associated acute respiratory distress syndrome treated with high-frequency oscillatory ventilation. Ann Thorac Med 2013; 8:124-6. [PMID: 23741277 PMCID: PMC3667442 DOI: 10.4103/1817-1737.109839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 05/07/2012] [Indexed: 11/29/2022] Open
Abstract
A 22-year-old obese asthmatic woman with Influenza A (H1N1)-associated acute respiratory distress syndrome died from cerebral artery gas emboli with massive cerebral infarction while being treated with High-Frequency Oscillatory Ventilation in the absence of a right to left intracardiac shunt. We review and briefly discuss other causes of systemic gas emboli (SGE). We review proposed mechanisms of SGE, their relation to our case, and how improved understanding of the risk factors may help prevent SGE in positive pressure ventilated patients.
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Affiliation(s)
- Christian M Sebat
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, California, United States
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Varlet V, Bouvet A, Augsburger M. L’argon : utilisations, toxicité et stratégie analytique en toxicologie médicolégale. ACTA ACUST UNITED AC 2013. [DOI: 10.1051/ata/2013025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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