Open AccessTransesophageal echocardiography detection of air embolism during endoscopic surgery and validity of hyperbaric oxygen therapy
Author(s) -
Ji-ling Guo,
Hanbing Wang,
Hong Wang,
Le Yue,
He Jian,
Xueqin Zheng,
Zhihao Zhang,
Guang-rong Duan
Publication year - 2021
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000026304
Subject(s) - medicine , air embolism , embolism , pulmonary embolism , pulmonary artery , circulatory system , circulatory collapse , oxygen therapy , surgery , anesthesia , cardiology , complication
Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism. Patient Concerns: We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers. Diagnoses: Based on E T CO 2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made. Interventions: The patients received symptomatic supportive therapy including CPR, 100% O 2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation. Outcomes: Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities. Conclusions: While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.