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Abstract
SUDDEN changes in nitrogen concentrations in inspired or expired gases can provide important diagnostic information. When end-tidal nitrogen concentration increases, an immediate search for a source of air entrainment is imperative. Venous air embolus, the most life-threatening cause of an increase in end-tidal N 2 concentration, must be distinguished from other sources of air. Increased expired N 2 can also originate from vaporizers, humidifiers, or air entrained from leaks in anesthesia circuits or gas sampling equipment. In this patient, a sudden increase in end-tidal N 2 concentration was caused by an undiagnosed bronchial-gastric fistula. The presence of end-tidal N 2 established a definitive diagnosis of a fistula, helped localize the fistula, and later confirmed endoscopic closure of the distal bronchial - gastric fistula.
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