Hyperbaric oxygen treatment to eliminate a large venous air embolism: a case study

Gas embolism, the entry of gas into vascular structures, can result in serious morbidity and death. It is an inadvertent clinical problem, but it also occurs in non-clinical environments. Gas embolisms result from procedures performed in almost all clinical specialties, thus making it a problem about which all clinicians should be aware. In most cases, gas embolism is air embolism, although it can result from the introduction of gases such as carbon dioxide, nitrous oxide and nitrogen. Gas embolism takes two forms, venous and arterial, distinguished by the mechanism of gas entry and the site where the emboli ultimately lodge. Techniques used to eliminate embolisms including administration of 100% oxygen, placing the patient in lateral decubitus, and Trendelenburg position for no longer than 10 minutes, removing the embolism with a catheter, surfactants and hyperbaric oxygen therapy (HBO2T). For venous gas embolisms surgical removal is recommended, while for arterial embolisms, HBO2T is highly recommended. Here we report on a patient who inadvertently received a venous infusion of 150 ml air resulting in a major embolism, and who underwent HBO2T, recovered well, and suffered no adverse events. This result suggests that it is important to consider HBO2T as a recommended application for patients with venous embolisms.