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Paradoxical Air Embolism Successfully Treated With Hyperbaric Oxygen

Section of Pulmonary/Critical Care Medicine, University of Wisconsin Hospital and Clinics

Aaron Joffe, DO

Department of Anesthesiology University of Wisconsin Hospital and Clinics, Madison, Wisconsin

Kenneth E. Wood, DO

Section of Pulmonary/Critical Care Medicine, University of Wisconsin Hospital and Clinics, kew{at}medicine.wisc.edu

The use of the central venous catheter may be complicated by air embolism when central venous pressure is subatmospheric and the catheter is open to the surrounding air. Paradoxical air embolus occurs when the gas bubbles are able to traverse a right to left shunt, gaining access to the systemic arterial circulation causing ischemic symptoms in end organs. In this article, a case of a patient with an unknown patent foramen ovale through which air entered the arterial circulation resulting in obtundation and stroke after inadvertent manipulation of a Hickman catheter is presented. The physiology, clinical manifestations, and management strategies are also discussed.

Key Words: air embolism • paradoxical embolism • catheter-related complications • hyperbaric oxygen

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