HBOT for Air Embolism Management
If you have had any procedure that could introduce air into your vessels resulting in air occluding critical vessels, you should consider Hyperbaric Oxygen Therapy. Means of introducing air can occur in a number of ways: diagnostic procedures such as needle biopsy, endoscopy, intravenous line introduction, intravenous fluid administration, angiography, air insufflation, trauma, intra-operative complications such as in neuro-surgical procedures, cardiac surgery, vascular surgery and pelvic surgery (in the Trendelenburg position). Rarely, oro-genital sex in pregnancy, faulty abortion and ingestion of large quantities of hydrogen peroxide solution. Most commonly since the presentation is clinical, a high index of clinical suspicion should be maintained. The findings may also be subtle. Response to HBOT is often the only way of proving it.
Air Embolism Management
Seizures may be lessened with HBOT, as well as, arrhythmias that may occur, as a result of air embolism. Careful oversight is mandated, so that everybody is prepared to re-institute HBOT, if a relapse occurs. Relapses may occur secondary to: white blood cell-mediated immune response, ischemic re-perfusion, re-embolization from the primary source. Repeat therapies aid in reducing embolic injury to all the organs, the reduction in swelling (edema), and a lowering in incidence of the development of late brain infarction (stroke). Initial management should consist of at least six managements of 96%-97% oxygen.
The management should be early with 96% – 97% oxygen plus 10 mg of dexamethasone to avoid cerebral edema. Complete or near complete recovery can occur even if HBOT is performed 48-54 hours after initial presentation. Further management includes:
- Antiplatelet medications
- Hemodilution with Dextran 40, as there is direct relationship between the hematocrir level and the degree of damage sustained
- George Allibone M.D.