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Neumoencéfalo a tensión, una extraña complicación del uso de oxígeno en neonatos. Descripción de un caso y revisión de la literatura. Neurocirugia (Astur) 2021; 32:84-88. [DOI: 10.1016/j.neucir.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/01/2019] [Accepted: 09/15/2019] [Indexed: 11/18/2022]
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2
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Lyons C, Callaghan M. Apnoeic oxygenation in paediatric anaesthesia: a narrative review. Anaesthesia 2020; 76:118-127. [PMID: 32592510 DOI: 10.1111/anae.15107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2020] [Indexed: 12/19/2022]
Abstract
Apnoeic oxygenation refers to oxygenation in the absence of any patient or ventilator effort to move the lungs. This phenomenon was first described in humans in the mid-20th century but has seen renewed interest in the last decade following the demonstration of apnoeic oxygenation with low-flow, and subsequently high-flow, nasal oxygen. This narrative review summarises our understanding of apnoeic oxygenation in the paediatric population. We examine the evidence supporting oxygenation via tracheal tube, modified laryngoscopes and nasal cannulae. The evidence for prolongation of safe apnoea time at induction of anaesthesia is also appraised. We explore the capacity for carbon dioxide clearance, flow rate selection with high-flow nasal oxygen and complications associated with the technique. It remains uncertain whether apnoeic oxygenation in paediatric patients results in a meaningful clinical benefit compared with standard care for outcomes such as the number of tracheal intubation attempts or the incidence of hypoxaemia. In particular, the role of apnoeic oxygenation in paediatric difficult airway management is unclear as this has not been the targeted focus of any published research to date.
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Affiliation(s)
- C Lyons
- Department of Anaesthesia, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - M Callaghan
- Department of Anaesthesia, Galway University Hospitals, Galway, Ireland
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3
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Castle-Kirszbaum M, Wang YY, King J, Uren B, Kim M, Danks RA, Goldschlager T. Tension Pneumocephalus from Positive Pressure Ventilation Following Endoscopic Skull Base Surgery: Case Series and an Institutional Protocol for the Management of Postoperative Respiratory Distress. World Neurosurg 2020; 141:357-362. [PMID: 32562901 DOI: 10.1016/j.wneu.2020.06.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Tension pneumocephalus (TP) is a rare but feared complication of endoscopic endonasal skull base surgery. In contrast to simple pneumocephalus, which is common after endoscopic transnasal approaches and managed conservatively, TP represents a neurosurgical emergency and mandates urgent decompression. CASE DESCRIPTION Here we present 2 cases of TP as a consequence of positive pressure ventilation following endoscopic endonasal skull base surgery. Both occurred during resuscitation for postoperative hypoxia. These cases prompted the development of an institution-wide protocol to identify and manage patients at risk of TP after extended skull base approaches. CONCLUSIONS To our knowledge, these are the only such cases of postoperative TP following positive pressure ventilation in the literature.
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Affiliation(s)
| | - Yi Yuen Wang
- Department of Neurosurgery, St Vincent's Health, Melbourne, Australia
| | - James King
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Australia
| | - Brent Uren
- Department of Ear, Nose and Throat Surgery, Monash Health, Melbourne, Australia
| | - Martin Kim
- Department of Anaesthesia, Monash Health, Monash University, Melbourne, Australia
| | - R Andrew Danks
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
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4
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Tension pneumo-orbit secondary to minor blunt force trauma. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:219-221. [DOI: 10.1016/j.anorl.2019.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/21/2019] [Indexed: 11/17/2022]
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Chang Y, Kim TG, Chung SY. High-flow Nasal Cannula-induced Tension Pneumocephalus. Indian J Crit Care Med 2020; 24:592-595. [PMID: 32963447 PMCID: PMC7482350 DOI: 10.5005/jp-journals-10071-23482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
High-flow nasal cannula (HFNC) therapy has been established as a promising oxygen treatment with various advantages for respiratory mechanics. One of the main mechanisms is to provide positive airway pressure. This effect could reduce lung injury and improve oxygenation; conversely, it may cause a complication of positive pressure ventilation. However, data are scarce regarding the possible adverse effects, particularly in adults. We report a patient who developed HFNC-induced tension pneumocephalus from an unrecognized skull base fracture. Physicians should be cautious when applying HFNC to patients with suspected skull base or paranasal sinus fracture, especially when applying a higher flow rate.
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Affiliation(s)
- Youjin Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Tae-Gyu Kim
- Department of Radiology, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Sun-Yoon Chung
- Department of Neurosurgery, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Republic of Korea
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Lyons C, Callaghan M. Uses and mechanisms of apnoeic oxygenation: a narrative review. Anaesthesia 2019; 74:497-507. [DOI: 10.1111/anae.14565] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2018] [Indexed: 12/31/2022]
Affiliation(s)
- C. Lyons
- Department of Anaesthesia; Mater Misericordiae University Hospital; Dublin Ireland
| | - M. Callaghan
- Department of Anaesthesia; Galway University Hospitals; Galway Ireland
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Iglesias-Deus A, Pérez-Muñuzuri A, López-Suárez O, Crespo P, Couce ML. Tension pneumocephalus induced by high-flow nasal cannula ventilation in a neonate. Arch Dis Child Fetal Neonatal Ed 2017; 102:F173-F175. [PMID: 28213557 DOI: 10.1136/archdischild-2015-309777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/08/2016] [Accepted: 09/25/2016] [Indexed: 11/04/2022]
Abstract
The use of high-flow nasal cannula (HFNC) therapy as respiratory support for preterm infants has increased rapidly worldwide. The evidence available for the use of HFNC is as an alternative to nasal continuous positive airway pressure (CPAP) and in particular to prevent postextubation failure. We report a case of tension pneumocephalus in a preterm infant as a complication during HFNC ventilation. Significant neurological impairment was detected and support was eventually withdrawn. Few cases of pneumocephalus as a complication of positive airway pressure have been reported in the neonatal period, and they all have been related to CPAP. This report reinforces the need to be aware of this rare but possible complication during HFNC therapy, as timely diagnosis and treatment can prevent neurological sequelae. We also stress the importance of paying close attention to flow rate, nasal cannula size and insertion, and mouth position, and of regularly checking insertion depth.
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Affiliation(s)
- Alicia Iglesias-Deus
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago, IDIS (Health Research Institute of Santiago de Compostela), Santiago de Compostela, Spain
| | - Alejandro Pérez-Muñuzuri
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago, IDIS (Health Research Institute of Santiago de Compostela), Santiago de Compostela, Spain
| | - Olalla López-Suárez
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago, IDIS (Health Research Institute of Santiago de Compostela), Santiago de Compostela, Spain
| | - Pilar Crespo
- Neonatal Unit, Department of Pediatrics, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Maria-Luz Couce
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago, IDIS (Health Research Institute of Santiago de Compostela), Santiago de Compostela, Spain
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Sugimoto A, Takahashi M, Shiraishi S, Watanabe M, Jiyong M, Tsuchida M. Pneumocephalus and subcutaneous scalp emphysema in a neonate on a low-flow nasal cannula. Gan To Kagaku Ryoho 2016; 64:277-9. [DOI: 10.1007/s11748-014-0454-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/11/2014] [Indexed: 10/25/2022]
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9
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Gurajala I, Azharuddin M, Gopinath R. General anaesthesia with laryngeal mask airway may cause recurrence of pneumocephalus in a patient with head injury. Br J Anaesth 2013; 111:675-6. [DOI: 10.1093/bja/aet316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Nicholson B, Dhindsa H. Traumatic tension pneumocephalus after blunt head trauma and positive pressure ventilation. PREHOSP EMERG CARE 2011; 14:499-504. [PMID: 20095833 DOI: 10.3109/10903120903564522] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pneumocephalus following head trauma is relatively rare, with tension pneumocephalus occurring in an even smaller group of patients. This review presents a recent case of tension pneumocephalus following the use of a manually operated bag-valve-mask to assist ventilations prior to rapid-sequence intubation. A discussion of this case in terms of other reported cases of pneumocephalus after oxygen therapy follows. A limited number of current case reports identified in the literature indicate a connection between pneumocephalus and positive pressure ventilation following blunt trauma. Continuous positive airway pressure (CPAP) ventilation use in patients with an undiagnosed skull fracture is the most common reported cause of ventilation-related pneumocephalus. The case review presented here identifies the use of a bag-valve-mask prior to intubation as a possible contributory cause of the tension pneumocephalus. With only one prior case reported in the literature of pneumocephalus following the use of a bag-valve-mask, this case is unique and may indicate the need for additional awareness for this rare complication. The prehospital diagnosis of pneumocephalus is difficult, as the symptoms and mechanism of injury mimic those associated with intracranial hemorrhage. The use of mannitol in the prehospital treatment of this patient and subsequent improvement in pupillary response may indicate that mannitol has a role in the treatment of tension pneumocephalus when neurosurgical services are not readily available. Additional research is needed to better understand the benefits and risks associated with this treatment modality.
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Affiliation(s)
- Benjamin Nicholson
- LifeEvac of Virginia, LifeEvac 3, 1000 Airport Road, Mattaponi, VA 23110, USA.
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11
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Moon HS, Lee SK, Chung SH, Chung JH, Chang IB. Recurred pneumocephalus in a head trauma patient following positive pressure mask ventilation during induction of anesthesia -A case report-. Korean J Anesthesiol 2010; 59 Suppl:S183-6. [PMID: 21286436 PMCID: PMC3030032 DOI: 10.4097/kjae.2010.59.s.s183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 03/15/2010] [Accepted: 04/13/2010] [Indexed: 12/04/2022] Open
Abstract
Pneumocephalus is a condition which usually results from head trauma. It has been known that iatrogenic pneumocephalus can occur as a complication of positive pressure mask ventilation during induction of anesthesia or ventilatory care for head trauma patients. We report a case of mask ventilation during anesthesia induction in a 50-year-old male patient with head trauma. Initial pneumocephalus associated with cerebrospinal fluid leakage was diagnosed immediate following head injury involving facial sinuses. He was managed with emergent lumbar drainage and supportive care. Pneumocephalus recurred following positive pressure mask ventilation (PPMV) during anesthesia induction for surgery on the right arm. Recurred pneumocephalus was managed with high flow oxygen and supportive care. Anesthesiologists should be aware of pneumocephalus as a potential complication of PPMV in head trauma patients, even after resolution of previous pneumocephalus.
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Affiliation(s)
- Hyun Soo Moon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Hallym University, Anyang, Korea
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12
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Jasin LR, Kern S, Thompson S, Walter C, Rone JM, Yohannan MD. Subcutaneous scalp emphysema, pneumo-orbitis and pneumocephalus in a neonate on high humidity high flow nasal cannula. J Perinatol 2008; 28:779-81. [PMID: 18974751 DOI: 10.1038/jp.2008.99] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
High humidity high flow nasal cannula has become a widely used alternative for nasal continuous positive airway pressure for the treatment of apnea of prematurity. We describe our experience of one incident of subcutaneous scalp emphysema, pneumo-orbitis and pneumocephalus with concomitant use of the high-flow nasal cannula.
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Affiliation(s)
- L R Jasin
- The Children's Medical Center of Dayton, One Children's Plaza, Dayton, OH 45458, USA.
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13
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Affiliation(s)
- Daniel E Jacome
- Department of Medicine, Franklin Medical Center, Greenfield, Mass, USA
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Cesareo E, Leroy P, Charron R, Noel M, Angenard F. [Pneumomediastinum and bilateral tension pneumothorax as a complication of oxygen therapy using a nasal cannula]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22:39-42. [PMID: 12738018 DOI: 10.1016/s0750-7658(02)00006-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the case of a patient who developed a subcutaneous and submucosal emphysema in association with a pneumomediastinum, a bilateral pneumothorax and a pneumoperitoneum. This complication was secondary to oxygen supply via a nasal cannula, which allowed a wrong submucosal pathway previously, created by the traumatic placement of a nasogastric tube. The evolution was uneventful. We comment the pathophysiological mechanism of such a complication and propose simple actions to prevent the reproduction.
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Affiliation(s)
- E Cesareo
- Département d'anesthésie, Polyclinique Saint-Joseph, 13, rue Vacheress, 77400 Lagny-sur-Marne, France.
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