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Oxygen Therapy with High-Flow Nasal Cannula as an Effective Treatment for Perioperative Pneumocephalus: Case Illustrations and Pathophysiological Review

Neurocritical Care volume 29, pages 366–373 (2018)Cite this article

Abstract

Pneumocephalus (PNC) is a condition in which when air is trapped inside the intracranial vault. The causes are varied, but include trauma and intracranial surgery. Treatment of PNC typically consists of augmenting patient oxygenation with the attempt of washing out pulmonary nitrogen, creating a gradient in which nitrogen in the intracranial air bubble diffuses out of the lungs via the blood. Though several high flow methods have been tested, the ideal mode of oxygenation has not fully been investigated. Here we present 3 cases of post-operative PNC who we felt were symptomatic from PNC. With administration of high-flow nasal cannula (HFNC), all patients improved both clinically and radiographically within a few hours, faster than in both anecdotal experience and published trials. Due to its steady FiO2 administration, positive pressure, comfort, and low side-effect profile, HFNC may be the ideal mode of oxygen delivery in PNC. We present a review of the physiology of PNC and the characteristics of several oxygen delivery systems to build a case for HFNC in this disease process.

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Jason L. Siegel

  2. Department of Critical Care, Mayo Clinic, Jacksonville, FL, 32224, USA

    Jason L. Siegel, Diane McLaughlin & Jose L. Diaz-Gomez

  3. Department of Respiratory Therapy, Mayo Clinic, Jacksonville, FL, 32224, USA

    Karen Hampton

  4. Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA

    Alejandro A. Rabinstein

  5. Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA

    Jose L. Diaz-Gomez

  6. Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, 32224, USA

    Jose L. Diaz-Gomez

Authors
  1. Jason L. Siegel
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  2. Karen Hampton
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  3. Alejandro A. Rabinstein
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  4. Diane McLaughlin
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  5. Jose L. Diaz-Gomez
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Correspondence to Jason L. Siegel.

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Dr. Siegel reports no disclosures. Mrs. Hampton reports no disclosures. Dr. Rabinstein reports no disclosures. Ms. McLaughlin reports no disclosures. Dr. Diaz-Gomez reports no disclosures.

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Siegel, J.L., Hampton, K., Rabinstein, A.A. et al. Oxygen Therapy with High-Flow Nasal Cannula as an Effective Treatment for Perioperative Pneumocephalus: Case Illustrations and Pathophysiological Review. Neurocrit Care 29, 366–373 (2018). https://doi.org/10.1007/s12028-017-0464-x

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  • DOI: https://doi.org/10.1007/s12028-017-0464-x

Keywords

  • Tension pneumocephalus
  • High-flow nasal cannula
  • Craniectomy
  • Oxygen therapy
  • Arterial oxygen partial pressure