SYSTEMIC GAS EMBOLISM COMPLICATING PULMONARY CONTUSION - DIAGNOSIS AND MANAGEMENT USING TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Systemic air embolism has been frequently reported after penetrating t horacic trauma. In blunt thoracic trauma, systemic air embolism has be en rarely diagnosed, and then only after an invasive procedure such as thoracotomy. Transesophageal echocardiography has been recently intro duced for the early assessment of trauma patients and is considered a sensitive noninvasive procedure to diagnose air embolism. We report th ree cases of systemic air embolism in patients with pulmonary contusio n secondary to a blunt thoracic trauma requiring controlled ventilatio n. Transesophageal echocardiography was performed for evaluation of he modynamic instability, and it showed air bubbles in the left atrium an d left ventricle during the insufflation phase, which disappeared duri ng apnea. A decrease in airway pressure (release of PEEP, low tidal vo lume, high frequency jet ventilation) significantly reduced the system ic air embolism. We concluded that systemic air embolism can occur aft er blunt thoracic trauma, and transesophageal echocardiography enables a rapid and accurate diagnosis that may be useful for therapeutic man agement.