LeDez Kenneth M, Zbitnew Geoff
Department of Anesthesia, Memorial University of Newfoundland, Health Sciences Centre, 300 Prince Phillip Drive, St. John's, Newfoundland A1B 3V6, Canada.
Can J Anaesth. 2005 Apr;52(4):403-8. doi: 10.1007/BF03016284.
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.
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.
Hyperbaric oxygen may be utilized to treat CAGE in small infants with right-to-left shunt and should be commenced promptly.
患有青紫型先天性心脏病的婴儿有因静脉输液管路发生脑动脉气体栓塞（CAGE）的风险。对在高压氧舱内护理此类患者的风险和难度的担忧可能会阻碍转诊。我们报告了一例复杂病例，其中一名小婴儿通过改良的高压氧治疗（HBOT）方案成功得到治疗。
一名4个月大、体重6.19千克的男婴近期因右心室双出口接受了格林分流术，在静脉注射药物后立即发生癫痫并变得不稳定。患者接受镇静、插管和通气，并开始使用多巴酚丁胺。10小时后进行的计算机断层扫描（CT）显示颅内有3个气泡。大约10小时后，患者被转诊接受高压氧治疗，随后在多人舱内很快开始治疗。由于右向左分流会大大增加因呼吸高压空气而患减压病的风险，因此通过采用减压的简化方案对高压氧治疗进行了改良。在24小时内于相当于2.15个绝对大气压的38英尺海水压力下进行了2次90分钟的高压氧治疗，期间无空气中断。治疗期间，婴儿使用牛津彭龙呼吸机进行通气。随后的CT扫描显示气泡消失。拔管后，除左臂有些无力外，他的神经功能似乎完好。
高压氧可用于治疗患有右向左分流的小婴儿的脑动脉气体栓塞，且应及时开始治疗。
