Am. J. Respir. Crit. Care Med., Vol 152, No. 2, 08 1995, 812-815.
Systemic gas embolism complicating pulmonary contusion. Diagnosis and management using transesophageal echocardiography
M Saada, JP Goarin, B Riou, JJ Rouby, Y Jacquens, R Guesde and P Viars
Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitie-Salpetriere, Paris VI University, France.
Systemic air embolism has been frequently reported after penetrating
thoracic trauma. In blunt thoracic trauma, systemic air embolism has been
rarely diagnosed, and then only after an invasive procedure such as
thoracotomy. Transesophageal echocardiography has been recently introduced
for the early assessment of trauma patients and is considered a sensitive
noninvasive procedure to diagnose air embolism. We report three cases of
systemic air embolism in patients with pulmonary contusion secondary to a
blunt thoracic trauma requiring controlled ventilation. Transesophageal
echocardiography was performed for evaluation of hemodynamic instability,
and it showed air bubbles in the left atrium and left ventricle during the
insufflation phase, which disappeared during apnea. A decrease in airway
pressure (release of PEEP, low tidal volume, high frequency jet
ventilation) significantly reduced the systemic air embolism. We concluded
that systemic air embolism can occur after blunt thoracic trauma, and
transesophageal echocardiography enables a rapid and accurate diagnosis
that may be useful for therapeutic management.
