Bubble-induced dysfunction in acute spinal cord decompression sickness

Francis, Tjr; Griffin, Jeffrey; Homer, L. D.; Pezeshkpour, G.; Dutka, A. J.; Flynn, ET

doi:10.1152/jappl.1990.68.4.1368

Cited by 26 publications

(11 citation statements)

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“…The dangerous form of DCS is affection of spinal cord leading to ascending paraesthesia and associated bowel and urinary bladder dysfunction. [34]…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Acute management of vascular air embolism

Shaikh

Ummunisa

2009

J Emerg Trauma Shock

125

108

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Vascular air embolism (VAE) is known since early nineteenth century. It is the entrainment of air or gas from operative field or other communications into the venous or arterial vasculature. Exact incidence of VAE is difficult to estimate. High risk surgeries for VAE are sitting position and posterior fossa neurosurgeries, cesarean section, laparoscopic, orthopedic, surgeries invasive procedures, pulmonary overpressure syndrome, and decompression syndrome. Risk factors for VAE are operative site 5 cm above the heart, creation of pressure gradient which will facilitate entry of air into the circulation, orogenital sex during pregnancy, rapid ascent in scuba (self contained underwater breathing apparatus) divers and barotrauma or chest trauma. Large bolus of air can lead to right ventricular air lock and immediate fatality. In up to 35% patient, the foramen ovale is patent which can cause paradoxical arterial air embolism. VAE affects cardiovascular, pulmonary and central nervous system. High index of clinical suspicion is must to diagnose VAE. The transesophgeal echocardiography is the most sensitive device which will detect smallest amount of air in the circulation. Treatment of VAE is to prevent further entrainment of air, reduce the volume of air entrained and haemodynamic support. Mortality of VAE ranges from 48 to 80%. VAE can be prevented significantly by proper positioning during surgery, optimal hydration, avoiding use of nitrous oxide, meticulous care during insertion, removal of central venous catheter, proper guidance, and training of scuba divers.

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“…The dangerous form of DCS is affection of spinal cord leading to ascending paraesthesia and associated bowel and urinary bladder dysfunction. [34]…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Acute management of vascular air embolism

Shaikh

Ummunisa

2009

J Emerg Trauma Shock

125

108

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“…This potentially adverse, but transient effect is unlikely to have any clinical implications as bubble radius is hardly changed and the overall speed of bubble resolution is greater during heliox (80:20) breathing when compared with continuous air breathing. Further, the injected bubbles studied in these experiments are several magnitudes larger than bubbles separated in tissues after decompression (Francis et al 1990; Hyldegaard and Madsen 1989). Accordingly, when air diving induced DCS is treated with recompression and heliox breathing, transient bubble growth will be even less likely.…”

Section: Discussionmentioning

confidence: 83%

Effect of isobaric breathing gas shifts from air to heliox mixtures on resolution of air bubbles in lipid and aqueous tissues of recompressed rats

2011

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Deep tissue isobaric counterdiffusion that may cause unwanted bubble formation or transient bubble growth has been referred to in theoretical models and demonstrated by intravascular gas formation in animals, when changing inert breathing gas from nitrogen to helium after hyperbaric air breathing. We visually followed the in vivo resolution of extravascular air bubbles injected at 101 kPa into nitrogen supersaturated rat tissues: adipose, spinal white matter, skeletal muscle or tail tendon. Bubbles were observed during isobaric breathing-gas shifts from air to normoxic (80:20) heliox mixture while at 285 kPa or following immediate recompression to either 285 or 405 kPa, breathing 80:20 and 50:50 heliox mixtures. During the isobaric shifts, some bubbles in adipose tissue grew marginally for 10–30 min, subsequently they shrank and disappeared at a rate similar to or faster than during air breathing. No such bubble growth was observed in spinal white matter, skeletal muscle or tendon. In spinal white matter, an immediate breathing gas shift after the hyperbaric air exposure from air to both (80:20) and (50:50) heliox, coincident with recompression to either 285 or 405 kPa, caused consistent shrinkage of all air bubbles, until they disappeared from view. Deep tissue isobaric counterdiffusion may cause some air bubbles to grow transiently in adipose tissue. The effect is marginal and of no clinical consequence. Bubble disappearance rate is faster with heliox breathing mixtures as compared to air. We see no reason for reservations in the use of heliox breathing during treatment of air-diving-induced decompression sickness.

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“…The spinal cord may be damaged either due to disruption of the white matter or due to the formation of platelet microthrombi in the spinal circulation. [6]…”

Section: Discussionmentioning

confidence: 99%

Decompression syndrome (Caisson disease) in an Indian diver

Phatak

David

Kulkarni

2010

Ann Indian Acad Neurol

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Acute decompression syndrome (Caisson’s disease) is an acute neurological emergency in divers. It is caused due to release of nitrogen gas bubbles that impinge the blood vessels of the spinal cord and brain and result in severe neurodeficit. There are very few case reports in Indian literature. There are multiple factors in the pathogenesis of Acute decompression syndrome (Caisson’s disease) such as health problems in divers (respiratory problems or congenital heart diseases like atrial septal defect, patent ductus arteriosus etc), speed of ascent from the depth and habits like smoking that render divers susceptible for such neurological emergency. Usually, immediate diagnosis of such a condition with MRI is not possible in hospitals in the Coastal border. Even though, MRI is performed, it has very low specificity and sensitivity. Facilities like hyperbaric oxygen treatment are virtually non-existent in these hospitals. Therefore, proper education of the divers and appropriate preventive measures in professional or recreational divers is recommended.

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Bubble-induced dysfunction in acute spinal cord decompression sickness

Cited by 26 publications

References 0 publications

Acute management of vascular air embolism

Acute management of vascular air embolism

Effect of isobaric breathing gas shifts from air to heliox mixtures on resolution of air bubbles in lipid and aqueous tissues of recompressed rats

Decompression syndrome (Caisson disease) in an Indian diver

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