Abstract
Purpose
Infants with cyanotic congenital heart disease are at risk for cerebral arterial gas embolism (CAGE) from iv infusion lines. Concern about the hazards and difficulty of caring for such patients inside a hyperbaric chamber may deter referral. We report a complex case in which a small infant was managed successfully using a modified hyperbaric oxygen treatment (HBOT) schedule.
Clinical features
A four-month-old 6.19 kg male infant with a recent Glenn shunt for double-outlet right ventricle had a seizure and became unstable immediately after an iv drug infusion. The patient was sedated, intubated and ventilated and dobutamine was commenced. A computerized tomography (CT) scan performed ten hours later demonstrated three intracranial air bubbles. About ten hours later the patient was referred for HBOT which commenced soon afterwards in a multiplace chamber. Since the rightto-left shunt would greatly increase the risk of decompression illness from breathing hyperbaric air HBOT was modified by the use of an abbreviated schedule at reduced pressure. Two 90-min HBOT sessions were administered within 24 hr at 38 feet of seawater pressure, equivalent to 2.15 atmospheres absolute without any air break. During treatment the infant was ventilated using an Oxford Penlon ventilator. A subsequent CT scan demonstrated the absence of air. After extubation he appeared neurologically intact except for some weakness of the left arm.
Conclusion
Hyperbaric oxygen may be utilized to treat CAGE in small infants with right-to-left shunt and should be commenced promptly.
Objectif
Les enfants atteints de cardiopathie cyanogène congénitale risquent de subir une embolie gazeuse de l’artère cérébrale (EGAC) à partir des cathéters pour perfusion iv. Les préoccupations concernant les dangers et la difficulté de soigner ces patients en chambre hyperbare peuvent retarder les demandes de consultation. Nous présentons un cas complexe de traitement réussi en utilisant un programme modifié d’oxygénothérapie hyperbare (OTHB).
éléments cliniques
Un bébé de quatre mois, de sexe masculin, pesant 6,19 kg, ayant subi récemment une opération de Glenn pour un ventricule droit à double issue, a été victime d’une convulsion et son état est devenu instable immédiatement après la perfusion iv d’un médicament. Nous avons donné un sédatif, intubé et ventilé le patient et amorcé un traitement à la dobutamine. Une tomographie réalisée dix heures plus tard, a montré trois bulles d’air intracrâniennes. Dix heures plus tard environ, le patient a été transféré pour une OTHB, commencée peu après dans une chambre multiplace. Comme le shunt droite-gauche pouvait augmenter beaucoup le risque de maladie de décompression en respirant de l’air hyperbare, l’OTHB a été modifiée par un programme abrégé à pression réduite. Il y a eu deux sessions d’OTHB de 90 min en 24 h à 38 pieds de pression (niveau de la mer), équivalente à 2,15 atmosphères absolues, sans coupure d’air. Pendant le traitement, l’enfant était ventilé avec un appareil Oxford Penlon. Une deuxième tomographie a montré l’absence d’air. Après l’extubation, l’enfant ne présentait aucune déficience neurologique, sauf pour une légère faiblesse du bras gauche.
Conclusion
L’oxygène hyperbare peut être utilisé pour traiter l’EGAC chez de jeunes enfants qui présentent un shunt droite-gauche et devrait être administré sans tarder.
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LeDez, K.M., Zbitnew, G. Hyperbaric treatment of cerebral air embolism in an infant with cyanotic congenital heart disease. Can J Anesth 52, 403–408 (2005). https://doi.org/10.1007/BF03016284
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DOI: https://doi.org/10.1007/BF03016284