Document Detail

Long-term outcome of iatrogenic gas embolism.
MedLine Citation:
PMID:  20221749     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To establish the incidence and long-term prognosis of iatrogenic gas embolism. METHODS: This was a prospective inception cohort. We included all consecutive adults with proven iatrogenic gas embolism admitted to the sole referral academic hyperbaric center in Paris. Treatment was standardized as one hyperbaric session at 4 ATA for 15 min followed by two 45-min plateaus at 2.5 then 2 ATA. Inspired fraction of oxygen was set at 100% during the entire dive. Primary endpoint was 1-year mortality. All patients had evaluation by a neurologist, visual field tested by Goldman kinetic perimetry and brain MRI or CT scan at 6 months and 1 year. RESULTS: From January 1993 to August 2004, 125 of 4,727,496 hospitalizations had proven iatrogenic gas embolism. The crude mortality was 25/119 (21%) at 1 year. Cardiac arrest at time of accident and ICU admission, and SAPS II of 33 or more were independent prognostic factors of 1-year mortality (OR = 4.39, 95% CI 1.46-12.20 and OR = 6.30, 1.71-23.21, respectively). Among ICU survivors, independent predictors of 1-year mortality were age (OR = 1.07, 1.01-1.14), Babinski sign (OR = 6.58, 1.14-38.20) and acute kidney failure (OR = 8.09, 1.28-51.21). Focal motor deficits (OR = 12.78, 3.98-41.09) and Babinski sign (OR = 6.76, 2.24-20.33) on ICU admission, and duration of mechanical ventilation of 5 days or more (OR = 15.14, 2.92-78.52) were independent predictors of long-term sequels. CONCLUSIONS: Gas embolism complicates 2.65 per 100,000 hospitalizations, and is associated with high mortality and morbidity. Babinski sign on ICU admission is associated with poor prognosis.
Jacques Bessereau; Nicolas Genotelle; Cendrine Chabbaut; Anne Huon; Alexis Tabah; Jérôme Aboab; Sylvie Chevret; Djillali Annane
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Publication Detail:
Type:  Journal Article     Date:  2010-03-11
Journal Detail:
Title:  Intensive care medicine     Volume:  36     ISSN:  1432-1238     ISO Abbreviation:  Intensive Care Med     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-10     Completed Date:  2010-10-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1180-7     Citation Subset:  IM    
General Intensive Care Unit, Hyperbaric Centre, Raymond Poincaré Hospital (AP-HP), University of Versailles SQY (UniverSud Paris), 104 boulevard Raymond Poincaré, 92380, Garches, France.
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MeSH Terms
Embolism, Air / diagnosis,  etiology*,  therapy*
Glasgow Coma Scale
Glasgow Outcome Scale
Hyperbaric Oxygenation*
Iatrogenic Disease*
Middle Aged
Prospective Studies
Risk Factors
Statistics, Nonparametric
Survival Analysis

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