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Zeljko Dujic - One of the best experts on this subject based on the ideXlab platform.
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exercise after scuba diving increases the incidence of Arterial Gas embolism
Journal of Applied Physiology, 2013Co-Authors: Dennis Madden, Zeljko Dujic, Mislav Lozo, Marko LjubkovicAbstract:Arterialization of Gas bubbles after decompression from scuba diving has traditionally been associated with pulmonary barotraumas or cardiac defects, such as the patent foramen ovale. Recent studies have demonstrated the right-to-left passage of bubbles through intrapulmonary Arterial-venous anastamoses (IPAVA) that allow blood to bypass the pulmonary microcirculation. These passages open up during exercise, and the aim of this study is to see if exercise in a postdiving period increases the incidence of Arterialization. After completing a dive to 18 m for 47 min, patent foramen ovale-negative subjects were monitored via transthoracic echocardiography, within 10 min after surfacing, for bubble score at rest. Subjects then completed an incremental cycle ergometry test to exhaustion under continuous transthoracic echocardiography observation. Exercise was suspended if Arterialization was observed and resumed when the Arterialization cleared. If Arterialization was observed a second time, exercise was terminated, and oxygen was administered. Out of 23 subjects, 3 Arterialized at rest, 12 Arterialized with exercise, and 8 did not Arterialize at all even during maximal exercise. The time for Arterialization to clear with oxygen was significantly shorter than without. Exercise after diving increased the incidence of Arterialization from 13% at rest to 52%. This study shows that individuals are capable of Arterializing through IPAVA, and that the intensity at which these open varies by individual. Basic activities associated with SCUBA diving, such as surface swimming or walking with heavy equipment, may be enough to allow the passage of venous Gas emboli through IPAVA.
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determinants of Arterial Gas embolism after scuba diving
Journal of Applied Physiology, 2012Co-Authors: Marko Ljubkovic, Jaksa Zanchi, Toni Breskovic, Jasna Marinovic, Mihajlo Lojpur, Zeljko DujicAbstract:Scuba diving is associated with breathing Gas at increased pressure, which often leads to tissue Gas supersaturation during ascent and the formation of venous Gas emboli (VGE). VGE crossover to sys...
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determinants of Arterial Gas embolism after scuba diving
Journal of Applied Physiology, 2012Co-Authors: Marko Ljubkovic, Jaksa Zanchi, Toni Breskovic, Jasna Marinovic, Mihajlo Lojpur, Zeljko DujicAbstract:Scuba diving is associated with breathing Gas at increased pressure, which often leads to tissue Gas supersaturation during ascent and the formation of venous Gas emboli (VGE). VGE crossover to systemic arteries (Arterialization), mostly through the patent foramen ovale, has been implicated in various diving-related pathologies. Since recent research has shown that Arterializations frequently occur in the absence of cardiac septal defects, our aim was to investigate the mechanisms responsible for these events. Divers who tested negative for patent foramen ovale were subjected to laboratory testing where agitated saline contrast bubbles were injected in the cubital vein at rest and exercise. The individual propensity for transpulmonary bubble passage was evaluated echocardiographically. The same subjects performed a standard air dive followed by an echosonographic assessment of VGE generation (graded on a scale of 0–5 ) and distribution. Twenty-three of thirty-four subjects allowed the transpulmonary passage of saline contrast bubbles in the laboratory at rest or after a mild/moderate exercise, and nine of them Arterialized after a field dive. All subjects with postdive Arterialization had bubble loads reaching or exceeding grade 4B in the right heart. In individuals without transpulmonary passage of saline contrast bubbles, injected either at rest or after an exercise bout, no postdive Arterialization was detected. Therefore, postdive VGE Arterialization occurs in subjects that meet two criteria: 1 ) transpulmonary shunting of contrast bubbles at rest or at mild/moderate exercise and 2 ) VGE generation after a dive reaches the threshold grade. These findings may represent a novel concept in approach to diving, where diving routines will be tailored individually.
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high incidence of venous and Arterial Gas emboli at rest after trimix diving without protocol violations
Journal of Applied Physiology, 2010Co-Authors: Marko Ljubkovic, Toni Breskovic, Jasna Marinovic, Ante Obad, Svein Erik Gaustad, Zeljko DujicAbstract:SCUBA diving is associated with generation of Gas emboli due to Gas release from the supersaturated tissues during decompression. Gas emboli arise mostly on the venous side of circulation, and they are usually eliminated as they pass through the lung vessels. Arterialization of venous Gas emboli (VGE) is seldom reported, and it is potentially related to neurological damage and development of decompression sickness. The goal of the present study was to evaluate the generation of VGE in a group of divers using a mixture of compressed oxygen, helium, and nitrogen (trimix) and to probe for their potential appearance in Arterial circulation. Seven experienced male divers performed three dives in consecutive days according to trimix diving and decompression protocols generated by V-planner, a software program based on the Varying Permeability Model. The occurrence of VGE was monitored ultrasonographically for up to 90 min after surfacing, and the images were graded on a scale from 0 to 5. The performed diving activities resulted in a substantial amount of VGE detected in the right cardiac chambers and their frequent passage to the Arterial side, in 9 of 21 total dives (42%) and in 5 of 7 divers (71%). Concomitant measurement of mean pulmonary artery pressure revealed a nearly twofold augmentation, from 13.6 ± 2.8, 19.2 ± 9.2, and 14.7 ± 3.3 mmHg assessed before the first, second, and the third dive, respectively, to 26.1 ± 5.4, 27.5 ± 7.3, and 27.4 ± 5.9 mmHg detected after surfacing. No acute decompression-related disorders were identified. The observed high Gas bubble loads and repeated microemboli in systemic circulation raise questions about the possibility of long-term adverse effects and warrant further investigation.
Wondwossen G Tekle - One of the best experts on this subject based on the ideXlab platform.
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factors associated with favorable response to hyperbaric oxygen therapy among patients presenting with iatrogenic cerebral Arterial Gas embolism
Neurocritical Care, 2013Co-Authors: Wondwossen G Tekle, Cheryl Adkinson, Saqib A Chaudhry, Vikram Jadhav, Ameer E Hassan, Gustavo J RodriguezAbstract:Background Iatrogenic cerebral Arterial Gas embolism (CAGE) is an uncommon but potentially a fatal condition. Hyperbaric oxygen (HBO2) therapy is the only definitive treatment for patients with CAGE presenting with acute neurologic deficits.
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factors associated with favorable response to hyperbaric oxygen therapy among patients presenting with iatrogenic cerebral Arterial Gas embolism
Neurocritical Care, 2013Co-Authors: Wondwossen G Tekle, Cheryl Adkinson, Saqib A Chaudhry, Vikram Jadhav, Ameer E Hassan, Gustavo J RodriguezAbstract:Iatrogenic cerebral Arterial Gas embolism (CAGE) is an uncommon but potentially a fatal condition. Hyperbaric oxygen (HBO2) therapy is the only definitive treatment for patients with CAGE presenting with acute neurologic deficits. We reviewed medical records and neuroimaging of consecutive CAGE patients treated with HBO2 at a state referral hyperbaric facility over a 22-year period. We analyzed the effect of demographics, source of intra-Arterial Gas, signs and symptoms, results of imaging studies, time between event and HBO2 treatment, and response to HBO2 treatment in 36 consecutive patients. Favorable outcome was defined by complete resolution or improvement of CAGE signs and symptoms at 24 h after HBO2 treatment. Unfavorable outcome was defined by unchanged or worsened neurologic signs and symptoms or in hospital death. A total of 26 (72%) of the 36 patients had favorable outcome. Patients with favorable outcome were younger compared to those with unfavorable outcome (mean age [years, SD] 44.7 ± 17.8 vs. 58.1 ± 24.1, p = 0.08). Cardiopulmonary symptoms were significantly more common in CAGE related to venous source of Gas compared to Arterial source (p = 0.024) but did not influence the rate of favorable outcomes. Adjusted multivariate analysis demonstrated that time from event to HBO2 ≤6 h (positively) and the presence of infarct/edema on head computerized tomography (CT)/magnetic resonance imaging (MRI) before HBO2 (negatively) were independent predictors of favorable outcome at 24 h after HBO2 treatment [odds ratio (OR) 9.08 confidence interval (CI) (1.13–72.69), p = 0.0376, and (OR) 0.034 (CI) (0.002–0.58), p = 0.0200, respectively]. Two of the 36 patients were treated with thrombolytics because of acute focal deficits and suspected ischemia—one with intravenous and the second with intra-Arterial thrombolysis. The latter patient developed fatal intracerebral hemorrhage. A high proportion of CAGE patients treated with HBO2 had favorable outcomes. Time-to-HBO2 ≤6 h increased the odds of favorable outcome, whereas the presence of infarct/edema on CT/MRI scan before HBO2 reduced the odds of a favorable outcome. Timely diagnosis and differentiation from thrombo-embolic ischemic events appears to be an important determinant of successful HBO2 treatment.
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abstract 3199 factors associated with favorable response to hyperbaric oxygen therapy among patients presenting with iatrogenic cerebral Arterial Gas embolism
Stroke, 2012Co-Authors: Wondwossen G Tekle, Cheryl Adkinson, Saqib A Chaudhry, Vikram Jadhav, Ameer E Hassan, Gustavo J Rodriguez, Adnan I QureshiAbstract:Background: Iatrogenic cerebral Arterial Gas embolism (CAGE) is an uncommon but potentially fatal condition. Hyperbaric oxygen (HBO 2 ) treatment is the only first line treatment for patients with CAGE presenting with acute neurological deficits. Methods: We reviewed medical records and neuroimaging of consecutive CAGE patients treated with HBO 2 at a state referral hyperbaric facility over a 22 year period. We analyzed the effect of demographics, source of intra-Arterial Gas, signs and symptoms, results of imaging studies, time between insult and HBO 2 treatment, and response to HBO 2 treatment in 36 consecutive patients. Favorable outcome was defined by complete resolution or improvement of CAGE signs and symptoms. Unfavorable outcome was defined by unchanged or worsened neurologic signs and symptoms or in hospital death. Results: A total of 26 (72%) of the 36 patients had favorable outcome. Patients with favorable outcome were younger compared to those with unfavorable outcome (mean age [years, SD] 44.7± 17.8 vs. 58.1 ± 24.1, p-value=0.08). Time-to-HBO 2 ≤ 6 hours was significantly associated with favorable outcome compared ≥ 6 hrs (p-value = 0.025). Cardiopulmonary symptoms associated with CAGE were significantly more common in venous source of Gas compared to Arterial (p-value = 0.024) but did not influence the rate of favorable outcomes. Two of 36 patients were treated with thrombolytics due to acute focal deficits and suspected ischemia - one with intravenous and the second one with intra-Arterial thrombolysis. The later patient developed fatal intracerebral hemorrhage. Conclusions: A high proportion of CAGE patients treated with HBO2 had favorable outcomes. Young age and time-to-HBO 2 ≤ 6 hours were associated with higher rate of favorable outcome. Timely diagnosis and differentiation from thrombo-embolic ischemic events is an important determinant of successful HBO2 treatment.
Robert P Weenink - One of the best experts on this subject based on the ideXlab platform.
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detection of cerebral Arterial Gas embolism using regional cerebral oxygen saturation quantitative electroencephalography and brain oxygen tension in the swine
Journal of Neuroscience Methods, 2014Co-Authors: Robert P Weenink, Markus F Stevens, Julian Kager, Robert A Van Hulst, Thomas M. Gulik, Markus W HollmannAbstract:Abstract Background Cerebral air emboli occur as a complication of invasive medical procedures. The sensitivity of cerebral monitoring methods for the detection of air emboli is not known. This study investigates the utility of electroencephalography and non-invasively measured cerebral oxygen saturation in the detection of intracerebrovascular air. New method In 12 pigs oxygen saturation was continuously measured using transcranial near-infrared spectroscopy and oxygen tension was continuously measured using intraparenchymal probes. Additionally, quantitative electroencephalography and microdialysis were performed. Doses of 0.2, 0.4, 0.8, and 1.6 ml of air were injected into the cerebral Arterial vasculature through a catheter. Results Oxygen saturation and electroencephalography both reacted almost instantaneously on the air emboli, but were less sensitive than the intraparenchymal oxygen tension. There was reasonable correlation (ρ ranging from 0.417 to 0.898) between oxygen saturation, oxygen tension, electroencephalography and microdialysis values. Comparison with existing methods Our study is the first to demonstrate the effects of cerebral air emboli using multimodal monitoring, specifically on oxygen saturation as measured using near-infrared spectroscopy. Conclusions Our results show that non-invasively measured oxygen saturation and quantitative electroencephalography can detect the local effects of air emboli on cerebral oxygenation, but with reduced sensitivity as compared to intraparenchymal oxygen tension. Prospective human studies using multimodal monitoring incorporating electroencephalography and oxygen saturation should be performed.
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hyperbaric oxygen does not improve cerebral function when started 2 or 4 hours after cerebral Arterial Gas embolism in swine
Critical Care Medicine, 2013Co-Authors: Robert P Weenink, Markus F Stevens, Markus W Hollmann, Xavier C.e. Vrijdag, Thomas M Van Gulik, Krijn P Van Lienden, Diederick W De Boo, Robert A. Van HulstAbstract:OBJECTIVE Hyperbaric oxygenation is the accepted treatment for cerebral Arterial Gas embolism. Although earlier start of hyperbaric oxygenation is associated with better outcome, it is unknown how much delay can be tolerated before start of hyperbaric oxygenation. This study investigates the effect of hyperbaric oxygenation on cerebral function in swine when initiated 2 or 4 hours after cerebral Arterial Gas embolism. DESIGN Prospective interventional animal study. SETTING Surgical laboratory and hyperbaric chamber. SUBJECTS Twenty-two Landrace pigs. INTERVENTIONS Under general anesthesia, probes to measure intracranial pressure, brain oxygen tension (PbtO2), and brain microdialysis, and electrodes for electroencephalography were placed. The electroencephalogram (quantified using temporal brain symmetry index) was suppressed during 1 hour by repeated injection of air boluses through a catheter placed in the right ascending pharyngeal artery. Hyperbaric oxygenation was administered using U.S. Navy Treatment Table 6 after 2- or 4-hour delay. Control animals were maintained on an inspiratory oxygen fraction of 0.4. MEASUREMENTS AND MAIN RESULTS Intracranial pressure increased to a mean maximum of 19 mm Hg (SD, 4.5 mm Hg) due to the embolization procedure. Hyperbaric oxygenation significantly increased PbtO2 in both groups treated with hyperbaric oxygenation (mean maximum PbtO2, 390 torr; SD, 177 torr). There were no significant differences between groups with regard to temporal brain symmetry index (control vs 2-hr delay, p = 0.078; control vs 4-hr delay, p = 0.150), intracranial pressure, and microdialysis values. CONCLUSIONS We did not observe an effect of hyperbaric oxygenation on cerebral function after a delay of 2 or 4 hours. The injury caused in our model could be too severe for a single session of hyperbaric oxygenation to be effective. Our study should not change current hyperbaric oxygenation strategies for cerebral Arterial Gas embolism, but further research is necessary to elucidate our results. Whether less severe injury benefits from hyperbaric oxygenation should be investigated in models using smaller amounts of air and clinical outcome measures.
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quantitative electroencephalography in a swine model of cerebral Arterial Gas embolism
Clinical Neurophysiology, 2012Co-Authors: Robert P Weenink, Markus F Stevens, Xavier C.e. Vrijdag, Michel J A M Van Putte, Markus W Hollma, Robe A Van Huls, Thomas M Van GulikAbstract:Abstract Objective Cerebral Arterial Gas embolism (CAGE) is a serious hazard in cardiovascular surgery and other invasive procedures. We used a swine model of CAGE to determine if quantitative electroencephalography (qEEG) is a useful tool in diagnosis and prognostication of CAGE. Methods 0.05 ml/kg of air was injected into the ascending pharyngeal artery in 16 pigs. Intracranial pressure, lactate in brain microdialysate and brain oxygen tension were measured during 4 h after embolization. The qEEG parameters mean amplitude (MAMP), alpha-delta ratio (ADR), spectral edge frequency (SEF 90 ), spatial brain symmetry index (sBSI) and temporal brain symmetry index (tBSI) were calculated. Results MAMP and tBSI but not ADR, SEF 90 and sBSI correlate with intracranial pressure, brain lactate and brain oxygen tension after 4 h. Early levels of MAMP and tBSI can predict intracranial pressure, brain lactate and brain oxygen tension after 4 h. Conclusions MAMP and tBSI are sensitive for cerebral injury and can predict outcome in a swine model of CAGE. Significance This study provides evidence for the utility of qEEG for diagnosis and prognosis in CAGE. Further studies are necessary to investigate the use of this method in patients.
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Animal models of cerebral Arterial Gas embolism
Journal of neuroscience methods, 2012Co-Authors: Robert P Weenink, Markus W Hollmann, Robert A. Van HulstAbstract:Cerebral Arterial Gas embolism is a dreaded complication of diving and invasive medical procedures. Many different animal models have been used in research on cerebral Arterial Gas embolism. This review provides an overview of the most important characteristics of these animal models. The properties discussed are species, cerebrovascular anatomy, method of air embolization, amount of air, bubble size, outcome parameters, anesthesia, blood glucose, body temperature and blood pressure.
Marko Ljubkovic - One of the best experts on this subject based on the ideXlab platform.
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exercise after scuba diving increases the incidence of Arterial Gas embolism
Journal of Applied Physiology, 2013Co-Authors: Dennis Madden, Zeljko Dujic, Mislav Lozo, Marko LjubkovicAbstract:Arterialization of Gas bubbles after decompression from scuba diving has traditionally been associated with pulmonary barotraumas or cardiac defects, such as the patent foramen ovale. Recent studies have demonstrated the right-to-left passage of bubbles through intrapulmonary Arterial-venous anastamoses (IPAVA) that allow blood to bypass the pulmonary microcirculation. These passages open up during exercise, and the aim of this study is to see if exercise in a postdiving period increases the incidence of Arterialization. After completing a dive to 18 m for 47 min, patent foramen ovale-negative subjects were monitored via transthoracic echocardiography, within 10 min after surfacing, for bubble score at rest. Subjects then completed an incremental cycle ergometry test to exhaustion under continuous transthoracic echocardiography observation. Exercise was suspended if Arterialization was observed and resumed when the Arterialization cleared. If Arterialization was observed a second time, exercise was terminated, and oxygen was administered. Out of 23 subjects, 3 Arterialized at rest, 12 Arterialized with exercise, and 8 did not Arterialize at all even during maximal exercise. The time for Arterialization to clear with oxygen was significantly shorter than without. Exercise after diving increased the incidence of Arterialization from 13% at rest to 52%. This study shows that individuals are capable of Arterializing through IPAVA, and that the intensity at which these open varies by individual. Basic activities associated with SCUBA diving, such as surface swimming or walking with heavy equipment, may be enough to allow the passage of venous Gas emboli through IPAVA.
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determinants of Arterial Gas embolism after scuba diving
Journal of Applied Physiology, 2012Co-Authors: Marko Ljubkovic, Jaksa Zanchi, Toni Breskovic, Jasna Marinovic, Mihajlo Lojpur, Zeljko DujicAbstract:Scuba diving is associated with breathing Gas at increased pressure, which often leads to tissue Gas supersaturation during ascent and the formation of venous Gas emboli (VGE). VGE crossover to sys...
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determinants of Arterial Gas embolism after scuba diving
Journal of Applied Physiology, 2012Co-Authors: Marko Ljubkovic, Jaksa Zanchi, Toni Breskovic, Jasna Marinovic, Mihajlo Lojpur, Zeljko DujicAbstract:Scuba diving is associated with breathing Gas at increased pressure, which often leads to tissue Gas supersaturation during ascent and the formation of venous Gas emboli (VGE). VGE crossover to systemic arteries (Arterialization), mostly through the patent foramen ovale, has been implicated in various diving-related pathologies. Since recent research has shown that Arterializations frequently occur in the absence of cardiac septal defects, our aim was to investigate the mechanisms responsible for these events. Divers who tested negative for patent foramen ovale were subjected to laboratory testing where agitated saline contrast bubbles were injected in the cubital vein at rest and exercise. The individual propensity for transpulmonary bubble passage was evaluated echocardiographically. The same subjects performed a standard air dive followed by an echosonographic assessment of VGE generation (graded on a scale of 0–5 ) and distribution. Twenty-three of thirty-four subjects allowed the transpulmonary passage of saline contrast bubbles in the laboratory at rest or after a mild/moderate exercise, and nine of them Arterialized after a field dive. All subjects with postdive Arterialization had bubble loads reaching or exceeding grade 4B in the right heart. In individuals without transpulmonary passage of saline contrast bubbles, injected either at rest or after an exercise bout, no postdive Arterialization was detected. Therefore, postdive VGE Arterialization occurs in subjects that meet two criteria: 1 ) transpulmonary shunting of contrast bubbles at rest or at mild/moderate exercise and 2 ) VGE generation after a dive reaches the threshold grade. These findings may represent a novel concept in approach to diving, where diving routines will be tailored individually.
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high incidence of venous and Arterial Gas emboli at rest after trimix diving without protocol violations
Journal of Applied Physiology, 2010Co-Authors: Marko Ljubkovic, Toni Breskovic, Jasna Marinovic, Ante Obad, Svein Erik Gaustad, Zeljko DujicAbstract:SCUBA diving is associated with generation of Gas emboli due to Gas release from the supersaturated tissues during decompression. Gas emboli arise mostly on the venous side of circulation, and they are usually eliminated as they pass through the lung vessels. Arterialization of venous Gas emboli (VGE) is seldom reported, and it is potentially related to neurological damage and development of decompression sickness. The goal of the present study was to evaluate the generation of VGE in a group of divers using a mixture of compressed oxygen, helium, and nitrogen (trimix) and to probe for their potential appearance in Arterial circulation. Seven experienced male divers performed three dives in consecutive days according to trimix diving and decompression protocols generated by V-planner, a software program based on the Varying Permeability Model. The occurrence of VGE was monitored ultrasonographically for up to 90 min after surfacing, and the images were graded on a scale from 0 to 5. The performed diving activities resulted in a substantial amount of VGE detected in the right cardiac chambers and their frequent passage to the Arterial side, in 9 of 21 total dives (42%) and in 5 of 7 divers (71%). Concomitant measurement of mean pulmonary artery pressure revealed a nearly twofold augmentation, from 13.6 ± 2.8, 19.2 ± 9.2, and 14.7 ± 3.3 mmHg assessed before the first, second, and the third dive, respectively, to 26.1 ± 5.4, 27.5 ± 7.3, and 27.4 ± 5.9 mmHg detected after surfacing. No acute decompression-related disorders were identified. The observed high Gas bubble loads and repeated microemboli in systemic circulation raise questions about the possibility of long-term adverse effects and warrant further investigation.
Gustavo J Rodriguez - One of the best experts on this subject based on the ideXlab platform.
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factors associated with favorable response to hyperbaric oxygen therapy among patients presenting with iatrogenic cerebral Arterial Gas embolism
Neurocritical Care, 2013Co-Authors: Wondwossen G Tekle, Cheryl Adkinson, Saqib A Chaudhry, Vikram Jadhav, Ameer E Hassan, Gustavo J RodriguezAbstract:Background Iatrogenic cerebral Arterial Gas embolism (CAGE) is an uncommon but potentially a fatal condition. Hyperbaric oxygen (HBO2) therapy is the only definitive treatment for patients with CAGE presenting with acute neurologic deficits.
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factors associated with favorable response to hyperbaric oxygen therapy among patients presenting with iatrogenic cerebral Arterial Gas embolism
Neurocritical Care, 2013Co-Authors: Wondwossen G Tekle, Cheryl Adkinson, Saqib A Chaudhry, Vikram Jadhav, Ameer E Hassan, Gustavo J RodriguezAbstract:Iatrogenic cerebral Arterial Gas embolism (CAGE) is an uncommon but potentially a fatal condition. Hyperbaric oxygen (HBO2) therapy is the only definitive treatment for patients with CAGE presenting with acute neurologic deficits. We reviewed medical records and neuroimaging of consecutive CAGE patients treated with HBO2 at a state referral hyperbaric facility over a 22-year period. We analyzed the effect of demographics, source of intra-Arterial Gas, signs and symptoms, results of imaging studies, time between event and HBO2 treatment, and response to HBO2 treatment in 36 consecutive patients. Favorable outcome was defined by complete resolution or improvement of CAGE signs and symptoms at 24 h after HBO2 treatment. Unfavorable outcome was defined by unchanged or worsened neurologic signs and symptoms or in hospital death. A total of 26 (72%) of the 36 patients had favorable outcome. Patients with favorable outcome were younger compared to those with unfavorable outcome (mean age [years, SD] 44.7 ± 17.8 vs. 58.1 ± 24.1, p = 0.08). Cardiopulmonary symptoms were significantly more common in CAGE related to venous source of Gas compared to Arterial source (p = 0.024) but did not influence the rate of favorable outcomes. Adjusted multivariate analysis demonstrated that time from event to HBO2 ≤6 h (positively) and the presence of infarct/edema on head computerized tomography (CT)/magnetic resonance imaging (MRI) before HBO2 (negatively) were independent predictors of favorable outcome at 24 h after HBO2 treatment [odds ratio (OR) 9.08 confidence interval (CI) (1.13–72.69), p = 0.0376, and (OR) 0.034 (CI) (0.002–0.58), p = 0.0200, respectively]. Two of the 36 patients were treated with thrombolytics because of acute focal deficits and suspected ischemia—one with intravenous and the second with intra-Arterial thrombolysis. The latter patient developed fatal intracerebral hemorrhage. A high proportion of CAGE patients treated with HBO2 had favorable outcomes. Time-to-HBO2 ≤6 h increased the odds of favorable outcome, whereas the presence of infarct/edema on CT/MRI scan before HBO2 reduced the odds of a favorable outcome. Timely diagnosis and differentiation from thrombo-embolic ischemic events appears to be an important determinant of successful HBO2 treatment.
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abstract 3199 factors associated with favorable response to hyperbaric oxygen therapy among patients presenting with iatrogenic cerebral Arterial Gas embolism
Stroke, 2012Co-Authors: Wondwossen G Tekle, Cheryl Adkinson, Saqib A Chaudhry, Vikram Jadhav, Ameer E Hassan, Gustavo J Rodriguez, Adnan I QureshiAbstract:Background: Iatrogenic cerebral Arterial Gas embolism (CAGE) is an uncommon but potentially fatal condition. Hyperbaric oxygen (HBO 2 ) treatment is the only first line treatment for patients with CAGE presenting with acute neurological deficits. Methods: We reviewed medical records and neuroimaging of consecutive CAGE patients treated with HBO 2 at a state referral hyperbaric facility over a 22 year period. We analyzed the effect of demographics, source of intra-Arterial Gas, signs and symptoms, results of imaging studies, time between insult and HBO 2 treatment, and response to HBO 2 treatment in 36 consecutive patients. Favorable outcome was defined by complete resolution or improvement of CAGE signs and symptoms. Unfavorable outcome was defined by unchanged or worsened neurologic signs and symptoms or in hospital death. Results: A total of 26 (72%) of the 36 patients had favorable outcome. Patients with favorable outcome were younger compared to those with unfavorable outcome (mean age [years, SD] 44.7± 17.8 vs. 58.1 ± 24.1, p-value=0.08). Time-to-HBO 2 ≤ 6 hours was significantly associated with favorable outcome compared ≥ 6 hrs (p-value = 0.025). Cardiopulmonary symptoms associated with CAGE were significantly more common in venous source of Gas compared to Arterial (p-value = 0.024) but did not influence the rate of favorable outcomes. Two of 36 patients were treated with thrombolytics due to acute focal deficits and suspected ischemia - one with intravenous and the second one with intra-Arterial thrombolysis. The later patient developed fatal intracerebral hemorrhage. Conclusions: A high proportion of CAGE patients treated with HBO2 had favorable outcomes. Young age and time-to-HBO 2 ≤ 6 hours were associated with higher rate of favorable outcome. Timely diagnosis and differentiation from thrombo-embolic ischemic events is an important determinant of successful HBO2 treatment.
