F. Dexter et Dk. Reasoner, THEORETICAL ASSESSMENT OF NORMOBARIC OXYGEN-THERAPY TO TREAT PNEUMOCEPHALUS - RECOMMENDATIONS FOR DOSE AND DURATION OF TREATMENT, Anesthesiology, 84(2), 1996, pp. 442-447
Background: Pneumocephalus has been linked to several clinical conditi
ons, including headache, lethargy, and even brain herniation or death.
The effects of different normobaric oxygen concentrations and duratio
ns of therapy on the rate of air absorption were examined. Methods: An
existing mathematical model of inert gas absorption was used. The mod
el accounts for the major phenomena that determine absorption of bubbl
es, including surface tension, pressure dependence of bubble size, and
removal of gases to the surrounding tissue. Sensitivity analysis test
ed reliability of our results. Results: Times for a 50-ml air collecti
on to have been absorbed were 5.8, 1.9, and 0.6 weeks at an FIo2, of 0
.21, 0.4, and 1.0, respectively. Thirty percent and 72% of the air was
absorbed in 2 days at an FIo2, of 0.4 and 1.0, respectively. The perc
ent decrease in time for absorption achieved by increasing the FIo2, f
rom 0.21 was nearly identical for different volumes of air. The benefi
t of increasing the FIo2, decreased with progressive increases in the
FIo2. Increasing the FIo2, from 0.21 to 0.4 caused the time to total a
ir absorption to decrease by 67%. In contrast, increasing the FIo2 fro
m 0.8 to 1.0 caused the time to total air absorption to decrease by an
additional 3%. Conclusions: Based on mathematical model predictions,
an FIo2, of 0.4 or 1.0 for at least 1 week or 2 days, respectively, wi
ll significantly decrease the time for absorption of a pneumocephalus.