PMID- 15814756
OWN - NLM
STAT- MEDLINE
DCOM- 20050728
LR  - 20161124
IS  - 0832-610X (Print)
IS  - 0832-610X (Linking)
VI  - 52
IP  - 4
DP  - 2005 Apr
TI  - Hyperbaric treatment of cerebral air embolism in an infant with cyanotic 
      congenital heart disease.
PG  - 403-8
AB  - PURPOSE: Infants with cyanotic congenital heart disease are at risk for cerebral 
      arterial gas embolism (CAGE) from iv infusion lines. Concern about the hazards 
      and difficulty of caring for such patients inside a hyperbaric chamber may deter 
      referral. We report a complex case in which a small infant was managed 
      successfully using a modified hyperbaric oxygen treatment (HBOT) schedule. 
      CLINICAL FEATURES: A four-month-old 6.19 kg male infant with a recent Glenn shunt 
      for double-outlet right ventricle had a seizure and became unstable immediately 
      after an iv drug infusion. The patient was sedated, intubated and ventilated and 
      dobutamine was commenced. A computerized tomography (CT) scan performed ten hours 
      later demonstrated three intracranial air bubbles. About ten hours later the 
      patient was referred for HBOT which commenced soon afterwards in a multiplace 
      chamber. Since the right-to-left shunt would greatly increase the risk of 
      decompression illness from breathing hyperbaric air HBOT was modified by the use 
      of an abbreviated schedule at reduced pressure. Two 90-min HBOT sessions were 
      administered within 24 hr at 38 feet of sea-water pressure, equivalent to 2.15 
      atmospheres absolute without any air break. During treatment the infant was 
      ventilated using an Oxford Penlon ventilator. A subsequent CT scan demonstrated 
      the absence of air. After extubation he appeared neurologically intact except for 
      some weakness of the left arm. CONCLUSION: Hyperbaric oxygen may be utilized to 
      treat CAGE in small infants with right-to-left shunt and should be commenced 
      promptly.
FAU - LeDez, Kenneth M
AU  - LeDez KM
AD  - Department of Anesthesia, Memorial University of Newfoundland, Health Sciences 
      Centre, 300 Prince Phillip Drive, St. John's, Newfoundland A1B 3V6, Canada. 
      kledez@mun.ca
FAU - Zbitnew, Geoff
AU  - Zbitnew G
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Can J Anaesth
JT  - Canadian journal of anaesthesia = Journal canadien d'anesthesie
JID - 8701709
SB  - IM
MH  - Embolism, Air/diagnostic imaging/*therapy
MH  - Heart Defects, Congenital/*complications
MH  - Humans
MH  - *Hyperbaric Oxygenation
MH  - Infant, Newborn
MH  - Intracranial Embolism/diagnostic imaging/*therapy
MH  - Male
MH  - Tomography, X-Ray Computed
EDAT- 2005/04/09 09:00
MHDA- 2005/07/29 09:00
CRDT- 2005/04/09 09:00
PHST- 2005/04/09 09:00 [pubmed]
PHST- 2005/07/29 09:00 [medline]
PHST- 2005/04/09 09:00 [entrez]
AID - 52/4/403 [pii]
AID - 10.1007/BF03016284 [doi]
PST - ppublish
SO  - Can J Anaesth. 2005 Apr;52(4):403-8. doi: 10.1007/BF03016284.