Cerebral venous air embolism treated with hyperbaric oxygen: a case report.

We present a case of cerebral venous gas embolism. Our patient made a complete neurological recovery after hyperbaric oxygen therapy (HBOT). The principles of HBOT, compressing and eliminating air bubbles and decreasing Β-2 integrin function, thus improving microcirculation, can only be beneficial in a situation where neurological damage is likely. Retrograde cerebral venous gas embolism is a less well recognised variant of gas embolism than the arterial variant. Its existence as a different entity is better recognised in the forensic medicine and radiology literature than in other disciplines. There is evidence in the literature of patients dying from this complication and others seemingly experiencing very little effect. This case report highlights this condition, to encourage others to look out for it and report outcomes, and to serve as a reminder that peripheral lines may be a potential cause of gas embolism, although the portal of air entry in our case remains uncertain.

Malfunction of the Siaretron 1000 Iper™ hyperbaric ventilator.

INTRODUCTION: Patient ventilators for use in the hyperbaric chamber need to be of special design; any malfunction could have disastrous consequences. We report two serious problems with a recently purchased Siaretron 1000 Iper™ ventilator. METHODS: The ventilator was tested with a Biotek VT-Plus™ gas flow analyzer, which also measures O2 concentration. The changes in fraction of inspiratory oxygen (FiO2) were verified with a Teledyne Electronic Devices™ O2 analyzer. RESULTS: In volume control ventilation (VCV) mode: excessively large tidal volumes were delivered when the fraction of inspiratory oxygen (FiO2) was changed. In pressure control ventilation (PCV) mode: changing the FiO2 setting did not change the FiO2 delivered by the ventilator. The ventilator also exhibited an irregular flow pattern in PCV. CONCLUSIONS: These problems may cause serious diagnostic and clinical consequences if not identified as equipment malfunction issues. A malfunction of the integrated memory in the microchip on the main board was said to cause the PCV malfunction. The manufacturer replaced the main board, which corrected the problem. The solution offered for the VCV problem was to change FiO2 in steps of 0.1 per breath, which eliminates the tidal volume surges. We feel it is extremely important that all users of the Siaretron 1000 Iper™ are made aware of these problems as they are not described in the user manual or elsewhere.