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Delayed systemic air embolism in a child with severe blunt chest trauma treated with high-frequency oscillatory

Jörg Brederlau1, Ralf M Muellenbach, Christian Wunder

  • 1Department of Intensive Care Medicine, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany. joerg.brederlau@helios-kliniken.de

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|March 25, 2011
PubMed

Insights

Blunt chest trauma can cause fatal arterial air embolism, even hours after ventilation begins. This case highlights a rare, late presentation of this severe pediatric injury.

Area of Science:

  • Pediatric Trauma Surgery
  • Critical Care Medicine
  • Pulmonary Embolism

Background:

  • Blunt chest trauma is a leading cause of pediatric mortality.
  • Hemoptysis following chest trauma indicates severe injury, risking exsanguination or arterial air embolism.
  • Cardiovascular collapse often follows intubation and positive pressure ventilation.

Observation:

  • A 13-year-old boy sustained blunt chest trauma after being hit by a car.
  • An alveolar to pulmonary venous fistula developed during lung protective ventilation, including high-frequency oscillatory ventilation.
  • Cerebral and coronary artery involvement led to irreversible damage and fatal collapse.

Findings:

  • Arterial air embolism presented atypically late, one hour after initiating positive pressure ventilation.
  • Necropsy revealed severe right lower lobe pulmonary damage involving pulmonary vessels.
  • Rapid diagnosis of the fistula did not prevent fatal outcomes.

Implications:

  • Blunt chest trauma with hemoptysis poses significant diagnostic and therapeutic challenges in children.
  • Delayed presentation of arterial air embolism requires heightened clinical suspicion.
  • This case underscores the critical need for advanced monitoring and rapid intervention in pediatric trauma patients with chest injuries.
Abstract

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