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Hyperbaric Oxygen Therapy For Venous Embolism

Medical information reviewed by: ANDREI BOGDAN, MD, Orthopedics-traumatology doctor
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Discover the hyperbaric medicine center opened in our clinic. Centrokinetic has the top-performing hyperbaric chamber in Bucharest, with multiple medical and anti-aging uses. The Baroks chamber has 5 seats, and operates at a constant pressure of 2.5 atmospheres, being fully automated and having protocols for each condition, and can be used individually for each patient. 

Hyperbaric oxygen therapy - benefits

Patients who use the clinic's hyperbaric therapy services benefit from:

  • The only medically accredited hyperbaric therapy chamber in Bucharest, which operates at 2.5 atmospheres (those for aesthetic use go to 1 atmosphere and have no medical benefits).
  • A safe medical procedure, without irradiation, without pain, without other side effects. 
  • The specialized medical team consists of recovery doctors, orthopedists, rheumatologists, neurologists, and neurosurgeons, meaning a multidisciplinary team specialized in all diseases that can be treated with hyperbaric therapy. 
  • Premium conditions at a fair price. Our clinic is recognized for the conditions offered and for the care of each patient. But we do not need to pay exorbitant prices to have access to quality medical services. At Centrokinetic you can find an affordable and fair price. But note that we do not have a contract with the National Health Insurance House (we do not offer state reimbursed services)

Centrokinetic is keeping contact with prestigious clinics and universities in Belgium, the Netherlands, France, and Greece to constantly update treatments to provide patients with the best medical solutions.

The results of hyperbaric therapy in venous air embolism

A man with neuromuscular respiratory failure requiring intubation and ventilation suffered a venous air embolism during inadequate administration of 5 ml of air. Ultrasound or CT confirmed an air embolism in the left subclavian vein, which was partially treated only by targeted aspiration. The embolism resolved completely during hyperbaric oxygen therapy, and the patient recovered without secondary complications of the embolism. Venous air embolism can cause neurological damage or even death if left untreated. When available, hyperbaric oxygen therapy appears to be an effective approach.

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Gas emboli, whether arterial or venous, can have significant neurological complications. Although seemingly rare, it is important to treat them promptly and to have a high degree of clinical suspicion for patients at risk. Although air embolism prevention is preferable, aspiration guided by interventional radiology or hyperbaric oxygen therapy (HBOT) are treatment options. 

The literature supports the effectiveness of HBOT as a treatment for cerebral air embolism, but less so for cerebral venous embolism. Air aspiration is often the first approach. This study provides an example of a patient in whom ultrasound aspiration failed, but HBOT subsequently was successful. Aspiration may not be successful and the patient should be re-examined if these attempts could delay transfer to an HBOT center.

A 71-year-old man had a one-week history of ascending lower limb weakness and shortness of breath. Non-invasive ventilation was required. He was treated for Guillain-Barré syndrome and sensory axonal polyneuropathy. He became increasingly hypoxemic, requiring urgent tracheal intubation and resuscitation, during which time he was accidentally given 5 ml of air from an empty syringe. Subsequent CT imaging confirmed an air embolism in the left subclavian vein presenting the risk of paroxysmal embolism or retrograde cerebral venous embolism. Aspiration was attempted, removing ∼1 ml of air. 

To minimize the risk of embolism and subsequent neurological complications, he was treated prophylactically with HBOT. No contraindications for hyperbaric treatment were known, and the transfer to the nearest interventional radiology unit requires inter-hospital transport, so it was subjected to the standard protocol in the hyperbaric chamber. At the beginning of the treatment, imaging confirmed that air can be seen in the left subclavian vein, which later disappeared during pressurization. With the reduction of the volume of bubbles obtained, the residual air should be able to reach the pulmonary capillary system or be absorbed safely.

Documented cerebral embolisms are rare, with the reported incidence of symptomatic cerebral gas embolism requiring HBOT ranging from 2.5 to 100,000 hospitalizations in Paris and Melbourne, according to data reported for the UK by the British Hyperbaric Association. Data on air embolism, in general, obtained from the Case Mix Program of the National Center for Audit and Research for Intensive Care reported 4.5 cases per 100,000 hospitalizations or six cases per year with a diagnosis of venous air embolism, embolism with arterial air, or both. Most cases of venous air embolism (VAE) are iatrogenic, classic as a result of neurosurgery in the sitting position, however, it is now known that embolism is associated with a variety of procedures.

Causes of complications in venous air emboli

Most venous air emboli are tiny and do not cause major clinical sequelae or do not require treatment, and the fatal doses are between 100 and 300 ml. However, small gas embolisms, as in this case, present serious risks, especially the complication of cerebral air embolism. 

There are several ways this can happen: 
  • Direct entry of gas into the cerebral arterial system (during angiography);
  • Pulmonary barotrauma resulting in gases in the pulmonary veins that subsequently enter the heart;
  • Paradoxical embolism, through which venous air enters the arterial system through an intracardiac sound from right to left or pulmonary arterio-venous malformations;
  • By suffocating the pulmonary capillary filtration mechanism;
  • Retrograde embolism 
The volume of the bubble seems to play a major role in the development of a retrograde embolism. Very small bubbles are usually compensated. Although the unusual entry of air into the bloodstream may be more frequent than reported, the larger the bubble, the greater the potential for retrograde translocation into the cerebral venous system and subsequent infarction. 

How do we prevent complications?

To prevent neurological complications, it is necessary to urgently remove the air bubble. HBOT reduces the volume of the bubble, helps eliminate nitrogen, and improves the oxygenation of potentially hypoxic tissue. 

Of the 441 (78%) patients with airborne embolism, 346 recovered fully when treated with HBOT, with only 20 (4%) dying, compared with 74 of 288 (26%) patients who did not receive any recompression therapy in total recovery and 52% died. Reports have shown the effectiveness of this therapy even when treatment is delayed by up to 21 hours. 

What are the effects of oxygen therapy on the body?

  • Decreases inflammation
  • Increases the body's oxygen saturation by 20-30%
  • Increases the body's immunity
  • Increases blood circulation and stimulates the formation of new capillaries
  • Decreases toxins in the body
  • Stimulates the production of new blood cells
  • Increases healing rate
While airway embolism can be assumed to have a faster onset and is more severe, a venous embolism can lead to significant neurological compromise and death. 

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The risks or practices of transferring a patient suspected of having an air embolism, to a specialized HBOT center, should be considered according to the benefits of HBOT, especially in people in serious condition. The specific risks of the hyperbaric environment to the patient and clinician must also be considered. Therefore, the management of each air embolism must be individualized according to the clinical context, emergency, and location. HBOT is proposed to be an alternative treatment for air embolism, especially if interventional radiology/aspiration has failed or is not available, or for treating air bubbles too small to be seen. 

Although the way air enters the veins is clear in this case, venous air embolism remains a recognized problem that, if left untreated, can lead to an irreversible neurological deficit and even death. Venous air embolism must be diagnosed and treated urgently, with HBOT providing an effective treatment option.

IN CASE YOU HAVEN'T ALREADY HEARD ABOUT US

Centrokinetic is the place where you will find clear answers and solutions for your motricity problems. The clinic is dedicated to osteoarticular diseases and is divided into the following specialized departments:

  • Orthopedics , a department composed of an extremely experienced team of orthopedic doctors, led by Dr. Andrei Ioan Bogdan, primary care physician in orthopedics-traumatology, with surgical activity at Medlife Orthopedic Hospital, specialized in sports traumatology and ankle and foot surgery. .
  • Pediatric orthopedics , where children's sports conditions are treated (ligament and meniscus injuries), spinal deformities (scoliosis, kyphosis, hyperlordosis) and those of the feet (hallux valgus, hallux rigidus, equine larynx, flat valgus, hollow foot).
  • Neurology , which has an ultra-performing department, where consultations, electroencephalograms (EEG) and electromyography (EMG) are performed. 
  • Medical recovery  for adults and  children , department specialized in the recovery of performance athletes, in spinal disorders, in the recovery of children with neurological and traumatic diseases. Our experience is extremely rich, treating over 5000 performance athletes.
  • Medical imaging , the clinic being equipped with ultrasound and MRI, high-performance devices dedicated to musculoskeletal disorders, and complemented by an experienced team of radiologists: Dr. Sorin Ghiea and Dr. Cosmin Pantu, specialized in musculoskeletal imaging.

Find the latest news by following the Facebook and YouTube accounts of the Centrokinetic clinic.  

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READ MORE