Hellinger L, Keppler A M, Schoeppenthau H, Perras J, Bender R
Department of Trauma Surgery and Intensive Care Medicine, BG Trauma Center Murnau, 82418, Murnau am Staffelsee, Germany.
Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany.
Anaesthesist. 2019 Jul;68(7):456-460. doi: 10.1007/s00101-019-0618-7. Epub 2019 Jul 1.
Iatrogenic arterial gas embolism (AGE) can be life-threatening. The only causal treatment is immediate hyperbaric oxygen therapy (HBOT). This article reports on a case of a 74-year-old male patient who underwent computed tomography (CT)-guided lung biopsy of suspect nodules after squamous cell carcinoma of the tonsils. During puncture, sudden cardiovascular arrest occurred. The CT scan documented severe arterial gas embolism in the aorta, spinal canal, left heart ventricle, and brain. The patient was then transferred to our hospital for HBOT. After the first HBOT, an additional CT scan showed regression of all gas inclusions. In the treatment of gas embolism, HBOT is considered the gold standard and is indispensable. It is primarily used to reduce acute bubble effects and to avoid secondary bubble effects. Unfortunately, the long persisting gas occlusions and perfusion deficits led to severe hypoxic brain damage and a poor prognosis for the patient. In this case report we present the management of (iatrogenic) arterial gas embolism and point out the necessity of immediate HBOT. Furthermore, we discuss the pathophysiology leading to arterial gas embolism on the basis of the gas laws.
医源性动脉气体栓塞（AGE）可能危及生命。唯一的因果治疗方法是立即进行高压氧治疗（HBOT）。本文报告了一例74岁男性患者，该患者在扁桃体鳞状细胞癌后接受了计算机断层扫描（CT）引导下对可疑结节进行的肺活检。穿刺过程中，患者突然发生心血管骤停。CT扫描显示主动脉、椎管、左心室和脑部存在严重的动脉气体栓塞。随后该患者被转至我院接受高压氧治疗。首次高压氧治疗后，再次进行CT扫描显示所有气体包裹均消退。在气体栓塞的治疗中，高压氧治疗被视为金标准且不可或缺。它主要用于减轻急性气泡效应并避免继发性气泡效应。不幸的是，长期持续的气体阻塞和灌注不足导致了严重的缺氧性脑损伤，患者预后不良。在本病例报告中，我们介绍了（医源性）动脉气体栓塞的处理方法，并指出了立即进行高压氧治疗的必要性。此外，我们根据气体定律讨论了导致动脉气体栓塞的病理生理学。
