[abstract] HYPERBARIC OXYGEN THERAPY (HBOT) OF IATROGENIC CEREBRAL ARTERIAL GAS EMBOLISM ( ICAGE ): EXPERIENCE FROM 1987 TO 1999.

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[abstract] HYPERBARIC OXYGEN THERAPY (HBOT) OF IATROGENIC CEREBRAL ARTERIAL GAS EMBOLISM ( ICAGE ): EXPERIENCE FROM 1987 TO 1999.

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Title: [abstract] HYPERBARIC OXYGEN THERAPY (HBOT) OF IATROGENIC CEREBRAL ARTERIAL GAS EMBOLISM ( ICAGE ): EXPERIENCE FROM 1987 TO 1999.
Author: Benson, JL; Adkinson, CD; Collier, RE
Abstract: Introduction: We describe this institution's experience of HBOT of ICAGEs, by determining mechanisms of gas introduction, presenting signs and symptoms, time from event of gas introduction to HBOT, relevance of diagnostic imaging, and patient outcomes. Methods: Information was collected from hospital and hyperbaric records for all patients referred for HBOT with ICAGE, from 1987 to 1999. Results: Twenty patients with ICAGEs were referred for HBOT, and 19 received HBOT using USAF Treatment Tables 6 or 6A. ICAGEs were all caused by 8 identified events, introducing gas into the venous or arterial circulation. Mean time from event to HBOT was 9 hrs (range 0-30). Immediately after HBOT, 4 patients completely resolved all signs and symptoms, 12 had improvement, 1 had no change, and 2 were not assessable secondary to chemically induced paralysis. Within 2 months post HBOT, 3 additional patients completely resolved, and 7 had further improvements. Of 10 patients with a venous source, their chest x-rays all showed pulmonary edema, and all patients experienced pulmonary signs or symptoms, i.e. shortness of breath or ARDS. Of 10 patients with an arterial source, their chest x-rays were clear, and no patients had pulmonary symptoms. Of imaging studies (head CT, MRI, EEG, TTE, and TEE) done prior to HBOT, 7 of 25 exams demonstrated gas and 5 had changes consistent with gas embolism. Conclusions: ICAGE patients improve with HBOT, and improvement may continue for several months after therapy. Awareness of the different symptom constellation for ICAGE from venous or arterial introduction of gas will assist the clinician in prompt recognition of ICAGE. All patients with ICAGE have neurologic symptoms by definition. In addition, patients with ICAGE from a venous source have pulmonary signs or symptoms. Diagnosis of ICAGE should be made on clinical suspicion with aide of, but not reliance on, imaging studies.
Description: Undersea and Hyperbaric Medical Society, Inc. (http://www.uhms.org )
URI: http://archive.rubicon-foundation.org/987
Date: 2001

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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