Concomitant paradoxıcal air embolism, in intensıve care unit: A rare case report

Fatma İrem Yeşiler; Deniz Sivrioğlu; Murathan Erkent; Helin Şahintürk; Pınar Zeyneloğlu; Zeynep Kayhan

Concomitant paradoxıcal air embolism, in intensıve care unit: A rare case report

authors
Fatma İrem Yeşiler, Deniz Sivrioğlu, Murathan Erkent, Helin Şahintürk, Pınar Zeyneloğlu, Zeynep Kayhan

abstract
Introduction: Paradoxical air embolism (PAE), as well as being a rare case, can often be fatal. It is mostly the consequence of an iatrogenic error related to various clinical, blood vessel-related procedures. There are still a significant number of deaths with a 1-year mortality of 21%, and almost 43% of intensive care unit (ICU) survivors had neurological sequels. Case: 56-year old male patient who underwent regular dialysis treatment due to the diagnosis of chronic renal failure, gastrectomy was performed due to gastrointestinal stromal tumor. On the postoperative 7th day, he was admitted to the ICU due to respiratory distress and change in consciousness after intermittent hemodialysis. APACHE II score was 39, SOFA score was 14 and GCS was 8. He was intubated and followed up with invasive mechanical ventilation, predicting that he would not be able to protect the airway due to change in consciousness and type I respiratory failure. The catheter was quickly changed after a fracture was detected in the permanent hemodialysis catheter. Due to hypotension, noradrenaline treatment was started in addition to fluid resuscitation. There were air bubbles into the main pulmonary artery in his thorax computed tomography and acute hypodense areas consistent with air embolism in the brain magnetic resonance imaging. Patent foramen ovale as demonstrated by injection of agitated saline in his transthoracic echocardiography. So, the change in consciousness was associated with paradoxical (concomitant) air embolism. The patient was extubated on the 3rd day of intubation and was discharged to the ward on the 26th day of the ICU follow-up with GCS 15. Conclusion: It is important to consider the diagnosis of air embolism in any patient with sudden hemodynamic or neurological deterioration in whom risk factors for air entry are present. Close follow-up in ICUs can provide satisfactory results in recovery.

Download | Pages : 27-31