Gas embolism and hyperbaric oxygen therapy: a case series

Figure 1. (a, b) A 66-year-old man with biliary pancreatitis developed left-sided weakness 5 minutes after urgentendoscopic retrograde cholangiopancreatography.Computed tomography of the brain revealed branching gasdensity in the right frontal and parietal lobes (arrows) Patient 6 A 72-year-old man underwent CT-guided fine needle aspiration cytology for a lung lesion. Patients treated with HBOT for cerebral arterial gas embolism Rationale for using hyperbaric oxygen therapy As soon as AGE is suspected, the patient should start receiving 100% high-flow oxygen and be placed in the right lateral decubitus position. Respiratory disturbances such as dyspnoea, cough or chest pain were present in 23% of patients.3 In a study of 45 patients with AGE, good neurological outcome was achieved in 27 (60%) of them.4 Time to receipt of HBOT was the only statistically significant factor predictive of a good outcome with mean delay 8.8 hours.4 Although probability of a good outcome is highest when HBOT is administered as soon as possible, a good response can still be obtained if treatment is delayed for longer than 24 hours.3 5 There is a tendency for patients with AGE to deteriorate after their initial apparent recovery; thus, early HBOT is still recommended for patients with a seemingly spontaneous recovery.6Although identification of gas bubbles on CT of the brain is not a prerequisite to HBOT, early treatment can also attenuate leucocyte adherence to damaged endothelium and secondary inflammation that in turn facilitate the return of blood flow. According to the Royal Navy Diving manual,12 which is commonly used in Europe, RN62 Table is the standard to treat AGE.