CASE REPORT
The effective use of hyperbaric oxygen therapy (HBOT) in the management of air embolism – rare and potentially fatal acute complication of hemodialysis
 
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1
Warmian-Masurian Cancer Center of the Ministry of the Interior and Administration’s Hospital in Olsztyn, Poland
 
2
Department of Internal Medicine and Nephrodiabetology, Medical University of Lodz, Poland
 
3
Department of Radiology, Military Institute of Medicine, Warsaw, Poland
 
4
Department of Hyperbaric Medicine, Military Institute of Medicine, Warsaw, Poland
 
5
Military Institute of Aviation Medicine, Center of Aeromedical Examination and Occupational Medicine
 
6
Department of Internal Diseases, Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland
 
 
Submission date: 2021-03-22
 
 
Final revision date: 2021-05-30
 
 
Acceptance date: 2021-05-31
 
 
Online publication date: 2021-11-09
 
 
Corresponding author
Sebastian Spaleniak   

Department of Internal Medicine and Nephrodiabetology, Medical University of Lodz, Żeromskiego 113, 90-549 Lodz, Poland.
 
 
Pol. Ann. Med. 2022;29(2):216-220
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Air embolism is a rare and potentially fatal acute complication. Its causes are mainly iatrogenic. It requires rapid diagnostics and treatment, including hyperbaric oxygen therapy (HBOT).

Aim:
The main aim was to present the potential causes of air embolism during hemodialysis (HD) and show the importance of quick clinical diagnosis and therapy – on the base of clinical case.

Case study:
65-years old male patient with diabetic nephropathy was treated with HD. The permanent dialysis catheters were used as vascular access due to the difficulties with formation of arteriovenous fistula. The massive air embolism occurred during one of the dialysis sessions. The clinical suspicion was confirmed by CT scan which showed the presence of gas bubbles in abdominal arteries. The cause of air embolism was sensor failure. The presence of patent foramen ovale (PFO) with reversed leakage caused the air ingress into arterial system. Patient was qualified for the immediate hyperbaric therapy. The quick improvement in the condition of the patient took place.

Results and discussion:
The massive air embolism may occur in HD patients, particularly in those who are dialyzed with use of catheters as vascular access. This rare complication should be considered in the case of sudden worsening of patient condition during HD procedure. The use of CT scan to confirm the air embolism suspicion and availability of HBOT are necessary for successful management of this complication.

Conclusions:
HBOT is a safe and effective method of air embolism treatment in HD patients.

 
REFERENCES (14)
1.
Saha M, Allon M. Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies. Clin J Am Soc Nephrol. 2017;12(2):357–369. https://doi.org/10.2215/cjn.05....
 
2.
Lanfranco J, Romero Legro I, Freire AX, Nearing K, Ratnakant S. Pulmonary Air Embolism: An Infrequent Complication in the Radiology Suite. Am J Case Rep. 2017;18:80–84. https://doi.org/10.12659/ajcr.....
 
3.
McCarthy CJ, Behravesh S, Naidu SG, Oklu R. Air Embolism: Practical Tips for Prevention and Treatment. J Clin Med. 2016;5(11):93. https://doi.org/10.3390/jcm511....
 
4.
Sato M, Kikuchi H, Takada K, et al. Transient portomesenteric venous gas in long-term hemodialysis patients. Radiat Med. 2005;23(8):570–573.
 
5.
Wong SS, Kwaan HC, Ing TS. Venous air embolism related to the use of central catheters revisited: with emphasis on dialysis catheters. Clin Kidney J. 2017;10(6):797–803. https://doi.org/10.1093/ckj/sf....
 
6.
Krajewski W, Godlewska-Tarka J. Air embolism [in Polish]. Forum Kardiol. 2003;8(1):39–43.
 
7.
Ward MK, Shadforth M, Hill AV, Kerr DN. Air embolism during haemodialysis. Br Med J. 1971;3(5766):74–78.
 
9.
Feil M. Preventing central line air embolism. Am J Nurs. 2015;115(6):64–69. https://doi.org/10.1097/01.naj....
 
10.
Presson RG Jr. Kirk KR, Haselby KA, et al. Fate of air emboli in the pulmonary circulation. J Appl Physiol. 1989;67(5):1898–1902. https://doi.org/10.1152/jappl.....
 
11.
Hysell MK. Cerebral air embolism after hemodialysis. J Emerg Med. 2015;49(1):27–28. https://doi.org/10.1016/j.jeme....
 
12.
Mirski MA, Lele AV, Fitzsimmons L, Toung TJ. Diagnosis and treatment of vascular air embolism. Anesthesiology. 2007;106(1):164–177. https://doi.org/10.1097/000005....
 
13.
Blanc P, Boussuges A, Henriette K, Sainty JM, Deleflie M. Iatrogenic cerebral air embolism: importance of an early hyperbaric oxygenation. Intensive Care Med. 2002; 28(5):559–563. https://doi.org/10.1007/s00134....
 
14.
Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017;47(1):24–32. https://doi.org/10.28920/dhm47....
 
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