Air Embolism Research Articles

Cerebral infarction by paradoxical gas embolism detected after laparoscopic partial hepatectomy with an insufflation management system: a case report

BackgroundLaparoscopic surgery has reduced surgical morbidity and postoperative duration of hospital stay. Gas embolism is commonly known as a risk factor for all laparoscopic procedures. We report a case of severe cerebral infarction presumably caused by paradoxical CO2 embolism in laparoscopic partial hepatectomy with an insufflation management system.Case presentationA male in his 60 s was diagnosed with recurrence of liver metastasis in the right hepatic lobe after laparoscopic lower anterior resection for rectal cancer. We performed laparoscopic partial hepatectomy with an AirSeal® under 10 mmHg of intra-abdominal pressure. During the surgery, the patient’s end-tidal CO2 and percutaneous oxygen saturation dropped from approximately 40–20 mmHg and 100–90%, respectively, while the heart rate increased from 60 to 120 beats/min; his blood pressure remained stable. Postoperatively, the patient developed right hemiplegia and aphasia. Brain magnetic resonance imaging showed cerebral infarction in the broad area of the left cerebral cortex. Thereafter, transesophageal echocardiography revealed a patent foramen ovale, suggesting cerebral infarction due to paradoxical gas embolism.ConclusionsA patent foramen ovale is found in approximately 15–20% of healthy individuals. While gas embolism is a rare complication of laparoscopic surgery, cerebral infarction must be considered a possible complication even if the intra-abdominal pressure is constant under 10 mmHg with an insufflation management system.

Abstract Number ‐ 126: Use of Woven EndoBridge device for Aneurysms in Off‐Labeled Locations: Systematic Review and Meta‐Analysis

Introduction The Woven EndoBridge (WEB) device was originally approved to treat intracranial wide‐necked saccular bifurcation aneurysms. Recent studies have suggested its use for the treatment of intracranial aneurysms (IA) in alternative locations with variable success. We aimed to evaluate the safety and efficacy of the WEB for IAs in off‐labeled locations using a meta‐analysis (MA) of the literature. Methods We performed a systematic review of all studies including patients treated with WEB for IAs in locations different than what is currently on‐label FDA until May 2022. Our primary efficacy and safety outcomes were adequate occlusion at last follow up and a composite of intraprocedural and postprocedural complications, respectively. The Raymond‐Roy (RR) scale and the Bicêtre Occlusion Scale Score (BOSS) were used to define complete (RR: 1; BOSS: 0‐0’) and adequate (RR:1‐2; BOSS: 0–2) occlusion. Additional safety outcomes included intraprocedural (thromboembolic, hemorrhagic, device deployment, or air embolism) and postprocedural (ischemic or hemorrhagic) complications, and mortality. We performed a random‐effects MA of proportions and assessed the certainty of the evidence using the GRADE approach. Statistical heterogeneity across studies was assessed with I2 statistics. Logistic regression of the patient level data was used to study the predictors of complete occlusion. Results Ten studies were selected, and 285 patients (79% female; mean age 58 years) with 288 aneurysms (35% ruptured) were included. Adequate and complete occlusion rates were 89% (95% CI 81–94%; I2 = 0%; moderate‐certainty evidence) and 64% (95% CI 57–70%; I2 = 13%; moderate‐certainty evidence), respectively. The composite safety outcome rate was 8% (95% CI 3–17%; I2 = 34%; very low‐certainty evidence). The intraprocedural and postprocedural complication rates were 6% (95% CI 4–10%; I2 = 0%; very low‐certainty evidence) and 1% (95% CI 0–1%; I2 = 33%; very low‐certainty evidence), respectively. The mortality rate was 2% (95% CI 1–7%; I2 = 0%; very low‐certainty evidence). Aneurysm width (OR = 0.5; p = 0.03) was the only significant predictor of complete occlusion. Conclusions The preliminary studies evaluating the use of WEB for the treatment of IAs in off‐labeled locations has demonstrated rates of adequate occlusion and procedural complications comparable to the landmark studies that evaluated the use of the WEB for on‐label bifurcation aneurysms. Given the level of evidence, we consider the interpretation of our results should be done cautiously until confirmation from larger prospective studies are obtained.

Carbon Dioxide Pyelography: A Convenient and Safe Alternative to Both Room Air and Iodinated Contrast Pyelography During Endourologic Procedures.

Introduction/Background: There are increasing reports of serious complications related to the air pyelography technique, which raise concerns about the safety of room air (RA) injection into the renal collecting system. Carbon dioxide (CO2) is much more soluble in blood than nitrogen and oxygen and thus considerably less likely to cause gas emboli. Iodinated contrast medium (ICM) is expensive, and supplies may not be as reliable as previously assumed. CO2 pyelography (CO2-P) techniques using standard fluoroscopy and digital subtraction fluoroscopy (CO2 digital subtraction pyelography [CO2-DSP]) are described. Materials and Methods: During the endourologic stone cases, 15 to 20 mL of CO2 gas was typically injected into the renal pelvis through a catheter or sheath. Imaging was usually obtained with endovascular CO2 digital subtraction angiography settings using either a traditional fluoroscopy system (TFS) or robotic arm multiplanar fluoroscopy system (RMPFS) (Artis Zeego Care+Clear®; Siemens). Results: CO2-P was performed in 22 endoscopic stone treatment cases between March 2021 and August 2022, primarily using digital subtraction settings in 20 cases. CO2-DSP overall provided higher quality images of the renal pelvis and collecting system than CO2-P, but with a relatively higher radiation dose. Following a quality intervention, fluoroscopy doses for CO2-DSP cases were decreased by 81% overall. The use of CO2-P avoided fluoroscopic or intraoperative CT (ICT) artifacts seen with intraluminal ICM. Conclusions: CO2-P allows the urologist to obtain imaging of the renal collecting system without ICM and with much lower risk of air embolism compared with RA pyelography. CO2 is a nearly cost-free alternative to ICM. Because CO2 is widely available and the technique is easy to perform, we propose that CO2-P should be favored over traditional air pyelography to improve patient safety.

Prevalence and Characteristics of Inspiration-Induced Negative Left Atrial Pressure during Pulmonary Vein Isolation.

Atrial fibrillation (AF) ablation is performed under deep sedation, which may cause inspiration-induced negative left atrial pressure (INLAP) associated with deep inspiration. INLAP could be the cause of periprocedural complications. We retrospectively enrolled 381 patients with AF (mean age, 63.9 ± 10.8 years; 76 women; 216 cases of paroxysmal AF) who underwent CA under deep sedation using an adaptive servo ventilator (ASV). Patients whose LAP was not obtained were excluded. INLAP was defined as <0 mmHg of mean LAP during inspiration immediately after the transseptal puncture. The primary and secondary endpoints were the presence of INLAP and the incidence of periprocedural complications. Among 381 patients, INLAP was observed in 133 (34.9%). Patients with INLAP had higher CHA2DS2-Vasc scores (2.3 ± 1.5 vs. 2.1 ± 1.6) and 3% oxygen desaturation indexes (median 18.6 (interquartile range 11.2-31.1) vs. 15.7 (8.1-25.3)), and higher prevalence of diabetes mellitus (23.3 vs. 13.3%) than patients without INLAP. Air embolism occurred in four patients with INLAP (3.0 vs. 0.0%). INLAP is not rare in patients undergoing CA for AF under deep sedation with ASV. Much attention should be paid to the possibility of air embolism in patients with INLAP.

Anesthesia management in a pediatric patient with craniopharyngioma

Craniopharyngiomas are the most common sellar or suprasellar tumors in childhood. The most critical issue in neuro anesthesia is to ensure adequate cerebral perfusion pressure and appropriate surgical conditions without disturbing the autoregulation of the cerebral circulation. The purpose of this article is to provide an overview of anesthetic management in successful craniopharyngioma surgery in pediatric patients. The purpose of this article is to provide an overview of anesthetic management in successful craniopharyngioma surgery in pediatric patients. Transsphenoidal pituitary surgery was planned. The patient, who had no intraoperative complications, was extubated postoperatively and transferred to the intensive care unit for close monitoring. Non-invasive monitoring (pulse oximetry, ECG, blood pressure, and temperature monitoring) was performed. A precordial USG was prepared to detect air embolism. Moderate hypothermia of 34-36°C was achieved. The patient, who had no intraoperative complications, was extubated postoperatively and transferred to the intensive care unit for close monitoring. The goals of anesthesia for transsphenoidal pituitary surgery include optimizing cerebral oxygenation, maintaining hemodynamic stability, managing intraoperative complications, and facilitating a rapid and smooth recovery.

Changes of 1, 5-AG in Vitreous Humor of Rabbit Cadavers with Hyperglycemic Metabolism.

To investigate the concentration and change characteristics of 1, 5-anhydroglucitol (1, 5-AG) in the vitreous humor of rabbit cadavers with hyperglycemic metabolism, and to explore the value of 1, 5-AG in forensic pathology identification of death caused by hyperglycemic metabolism disorders. A diabetic hyperglycemic rabbit model was established by using alloxan. Eighteen rabbits with fasting glucose concentration ≥13.80 mmol/L (experimental group) and 18 healthy rabbits with fasting glucose concentration ≤6.10 mmol/L (control group) were selected. After death from air embolism. The blood samples were collected immediately, and vitreous humor samples were collected at 0 h, 12 h, 24 h and 36 h after death. The concentration of 1, 5-AG in the blood and vitreous humor of rabbits was determined. The blood glucose concentration in the experimental group was (25.10±3.14) mmol/L. At the time of death, there was no significant difference in the concentration of 1, 5-AG in the blood [(0.94±0.20) μg/mL] and in the vitreous humor (0.99±0.05 μg/mL, P>0.05). The concentration of 1, 5-AG in the vitreous humor of the experimental group was lower than that of the corresponding control group at all time points (P<0.05), and there was no significant difference betwwen 1, 5-AG concentration in vitreous humor between earch time point in the experimental group and the control group (P>0.05). Correlation analysis showed that the concentration of 1,5-AG in blood was negatively correlated with blood glucose in both control group and experimental group (control group: r=-0.79, P<0.05; experimental group: r=-0.97, P<0.05). Vitreous humor can replace blood as an effective test sample for 1,5-AG detection. The concentration of 1, 5-AG in rabbit vitreous humor remains stable within 36 hours after death and is not affected by the change of postmortem interval. If the concentration of 1, 5-AG decreases significantly, it indicates the existence of hyperglycemia in rabbits before death.

Research on the characteristics of drought stress state based on plant stem water content

There is a close relationship between plant stem moisture and plant drought stress. In this study, we tried to explore the variation law of stem water content of plants of different body types under drought stress. In this paper, small Cinnamomum kotoense Kanehira et Sasaki and large Malus micromalus Makino were used as materials to create a drought stress state by artificially controlling the amount of irrigation water, and the change law of plant stem water during this period was analyzed. The results showed that the ability of large mature trees to cope with drought stress was stronger, and the stem water content could be maintained for a longer time under drought stress. Large trees are more resilient after watering. Small plants are more prone to air embolism due to drought stress due to their thin stems, blocking water transport and causing plant death. Recovery is weaker after watering. In this experiment, when the degree of drought stress exceeds 70%, there is a threshold of plant death. When the degree of stress exceeds this threshold, there is a high probability of eventual death. At this point the stem water will be irreversibly lost, and even watering will not be able to restore it. In this study, it was also found that the change of plant stem water under drought stress would have a lag, and the higher the stress level, the greater the lag degree. In this study, the plant state under drought stress was analyzed by the stem water of the plant, which can judge the current life state of the plant more quickly and easily. This could turn into a more efficient way of analyzing plants in the future.

How to position the patient? A meta-analysis of positioning in vestibular schwannoma surgery via the retrosigmoid approach.

Patient positioning is a matter of ongoing debate in the surgical treatment of vestibular schwannoma (VS). Main endpoints of this discussion are preservation of facial nerve functioning, extent of resection, and complications. In this meta-analysis, we aim to investigate the impact of patient positioning on VS surgery via the retrosigmoid approach. We searched for eligible comparative trials on PubMed, Cochrane library, and Web of Science. Positioning groups were compared regarding facial nerve outcome, extent of resection, postoperative hydrocephalus, postoperative CSF leaks, perioperative venous air embolism, and perioperative mortality. Two groups of positions were defined, and the following positions were allocated to those groups: (1) Semi-sitting and Sitting-position; (2) Lateral position, supine position with extensive head rotation, lateral oblique (=Fukushima/Three-quarter prone), and park-bench position. From 374 full-text screenings, 7 studies met the criteria and were included in our meta-analysis comprising 1640 patients. Our results demonstrate a significantly better long-term (≥6 months) outcome of the facial nerve after VS surgery in the semi-sitting positioning (OR: 1.49, 95%CI: 1.03-2.15, p = 0.03). Positioning did not influence the extent of resection, rate of postoperative CSF leaks, and the presence of a postoperative hydrocephalus. Overall incidence of venous air embolisms was significantly associated with VS surgery in sitting positioning (OR: 6.77, 95% CI: 3.66-12.54, p < 0.00001). Perioperative mortality was equal among both positioning groups. Semi-sitting positioning seems to be associated with an improved facial nerve outcome after VS surgery via the retrosigmoid approach. Venous air embolisms are significantly more often observed among VS patients who underwent surgery in the sitting position, but the perioperative mortality is equal in both positioning groups. Both positioning groups are a safe procedure. Multicentric prospective randomized trials are needed to evaluate the risk-benefit ratio of each positioning in VS surgery via the retrosigmoid approach.

Pulmonary barotrauma in SCUBA diving-related fatalities: a histological and histomorphometric analysis

Arterial gas embolism following pulmonary barotrauma occurs in 13–24% of cases of diving deaths. The study aimed to evaluate the usefulness of a histomorphometric digital analysis in the detection of air space over-distension due to pulmonary barotrauma. The study was performed on lung parenchyma specimens of 12 divers: six had died due to arterial gas embolism following pulmonary barotrauma (mean age at death of 54 years, range of 41–61 years), and six had drowned in saltwater without a diagnosis of pulmonary barotrauma (mean age at death of 54 years, range of 41–66 years) (positive controls). For negative controls, six cases of non-SCUBA divers (mean age of death of 42 years, range of 23–55 years) who died of intracerebral haemorrhage were evaluated. No significant differences were observed in the characteristics of the air spaces between control groups (positive and negative). However, differences were observed in the area occupied by air spaces and the percentage of air space area when we compared the case group to the controls (p < 0.01); and there was a slight difference in the maximum and minimum diameters of air space (p < 0.05). The mean area occupied by air spaces and the mean percentage of air space were the most useful for discriminating pulmonary barotrauma from other causes of death (100% sensitivity and 91.7% specificity). Based on our study, inclusion of an increased pattern of air spaces as a possible diagnostic criterion for pulmonary barotrauma would be useful in discerning the cause of diving death.

Catastrophic and Critical Intraoperative Events during Pediatric Craniofacial Surgery.

The data reviewed included the operative procedures of two senior craniofacial surgeons over an 18-year period at a tertiary care pediatric craniofacial center. Catastrophic or critical intraoperative events were defined as events requiring the activation of an emergency code during surgery. The operative details and acute outcomes were reviewed and analyzed. This study reviewed 7214 procedures performed between January 2002 and January 2019. There were 2072 (29%) cases classified as major craniofacial procedures (transcranial, mixed trans-and-extracranial, or major extracranial facial osteotomies), and code events occurred in 14 cases (0.67%; one in 148 patients): venous air embolism (n = 4), cardiac complications (n = 3), major hemorrhage (n = 3), trigeminocardiac reflex (n = 2), acute intracranial hypertension (n = 1), and acute airway obstruction (n = 1). Two cases (14%) experienced a critical event that was anesthesia-related. Cardiac arrest requiring compressions and/or defibrillation was necessary for eight patients. There were no mortalities. Surgery was curtailed in seven cases and successfully completed in seven patients. Catastrophic life-threatening events during pediatric craniofacial surgery are, fortunately, rare. In our institution, experienced teams in the management of catastrophic and critical intraoperative events during major pediatric craniofacial procedures resulted in no mortalities.

Clinical Characteristics, Imaging Findings, and Outcomes of Cerebral Air Embolism.

Arterial cerebral air embolism (CAE) is an uncommon but potentially catastrophic event. Patients can present with focal neurologic deficits, seizures, or coma. They may be treated with hyperbaric oxygen therapy. We review the causes, radiographic and clinical characteristics, and outcomes of patients with CAE. We performed a retrospective chart review via an existing institutional database at Mayo Clinic to identify patients with arterial CAE. Demographic data, clinical characteristics, and diagnostic studies were extracted and classified on predefined criteria of diagnostic confidence, and descriptive and univariate analysis was completed. Fifteen patients met criteria for inclusion in our study. Most presented with focal deficits (80%) and/or coma (53%). Seven patients (47%) had seizures, including status epilepticus in one (7%). Five presented with increased muscle tone at the time of the event (33%). Computed tomography (CT) imaging was insensitive for the detection of CAE, only identifying free air in 4 of 13 who underwent this study. When obtained, magnetic resonance imaging typically showed multifocal areas of restricted diffusion. Six patients (40%) were treated with hyperbaric oxygen therapy. Age, Glasgow Coma Scale score at nadir, and use of hyperbaric oxygen therapy were not associated with functional outcome at 1year in our cohort. Twenty-six percent of patients had a modified Rankin scale score of 0 one year after the event, and functional improvement over time was common after discharge. A high index of clinical suspicion is needed to identify patients with CAE because of low sensitivity of free air on CT imaging and nonspecific clinical presentation. Acute alteration of consciousness, seizures, and focal signs occur frequently. Because improvement over time is possible even among patients with severe presentation, early prognostication should be approached with caution.

Novel device for automating exchange transfusions through umbilical venous route in neonates.

Our prototype of a novel device can safely automate a DVET. Further trials of this device are warranted. •Double volume exchange transfusion is often performed manually, but this is time-consuming and error-prone. •Previous attempts at automation were not widely adopted because they involved inserting two catheters and did not have mechanisms to prevent embolism. •This novel device fully automates double volume exchange transfusions through a single-lumen umbilical venous catheter. •It prevents air and clot embolism and has a screen for input and output parameters and alarms.

Laparoscopic left hepatectomy in a goat as a training model for laparoscopic anatomic liver resection: results of training courses with a total of 70 goats.

To create a suitable animal model for the training of laparoscopic anatomic liver resection, we performed left hepatectomy using a goat and found its suitability. We have since started using goats for wet-lab training and have gradually standardized the relevant procedures. Herein, we report our standardized training procedures using a goat and discuss its feasibility as a novel training model. The standardized wet-lab training courses of laparoscopic liver resection conducted on 62 tables with a total of 70 goats were reviewed. The training course began by encircling the hepatoduodenal ligament for the Pringle maneuver, which was repeated during the parenchymal dissection. Following partial liver resection of the left lateral section, left hepatectomy was performed by a standardized procedure for humans in which the liver was split, exposing the entire length of the middle hepatic vein trunk from the dorsal side after extrahepatic transection of the left Glissonean pedicle. If a goat deceased before initiating left hepatectomy, the training was restarted with a new goat. The surgical procedures were performed by surgeons of varying skill levels. A total of 184 surgeons including 10 surgical residents participated in the training. Partial liver resection was initiated in 62 tables, with 8 (13%) dying during or after the procedure of partial liver resection. Subsequently, left hepatectomy was initiated in 61 and completed in 59 tables (98%), regardless of whether the goat survived or deceased, and was not completed in 2 tables (3%) due to time limitation. In 14 tables (23%), the goats deceased during the procedure, however, the procedure was completed. The causes of death were multifactorial, including massive bleeding, reperfusion injury after the Pringle maneuver, and carbon dioxide gas embolism. Left hepatectomy in a goat is useful as a training model for laparoscopic anatomic liver resection.

Combined autologous blood patch-immediate patient rollover does not reduce the pneumothorax or chest drain rate following CT-guided lung biopsy compared to immediate patient rollover alone

PuproseThe purpose of this study was to evaluate a combined autologous blood-patch (ABP)-immediate patient rollover (IPR) technique compared with the IPR technique alone on the incidence of pneumothorax and chest drainage following CT-guided lung biopsy. MethodsIn this interventional cohort study of both prospectively and retrospectively acquired data, 652 patients underwent CT-guided lung biopsy. Patient demographics, lesion characteristics and technical biopsy variables including the combined ABP-IPR versus IPR alone were evaluated as predictors of pneumothorax and chest drain rates using regression analysis. ResultsThe combined ABP-IPR technique was performed in 259 (39.7 %) patients whilst 393 (60.3 %) underwent IPR alone. There was no significant difference in pneumothorax rate or chest drains required between the combined ABP-IPR vs IPR groups (p =.08, p =.60 respectively). Predictors of pneumothorax adjusted for the combined ABP-IPR and IPR alone groups included age (p =.02), lesion size (p =.01), location (p =.005), patient position (p =.008), emphysema along the needle track (p =.005) and lesion distance from the pleura (p =.02). Adjusted predictors of chest drain insertion included lesion location (p =.09), patient position (p =.002), bullae crossed (p =.02) and lesion distance from the pleura (p =.02). ConclusionThe combined ABP-IPR technique does not reduce the pneumothorax or chest drain rate compared to the IPR technique alone.Utilising IPR without an ABP following CT-guided lung biopsy results in similar pneumothorax and chest drain rates while minimising the potential risk of systemic air embolism.

Treatment of hepatic venous system hemorrhage and carbon dioxide gas embolization during laparoscopic hepatectomy via hepatic vein approach.

With the improvement of laparoscopic surgery, the feasibility and safety of laparoscopic hepatectomy have been affirmed, but intraoperative hepatic venous system hemorrhage and carbon dioxide gas embolism are the difficulties in laparoscopic hepatectomy. The incidence of preoperative hemorrhage and carbon dioxide gas embolism could be reduced through preoperative imaging evaluation, reasonable liver blood flow blocking method, appropriate liver-breaking device, controlled low-center venous pressure technology, and fine-precision precision operation. In the case of blood vessel rupture bleeding in the liver vein system, after controlling and reducing bleeding, confirm the type and severity of vascular damage in the liver and venous system, take appropriate measures to stop the bleeding quickly and effectively, and, if necessary, transfer the abdominal treatment in time. In addition, to strengthen the understanding, prevention and emergency treatment of severe CO2 gas embolism in laparoscopic hepatectomy is also the key to the success of surgery. This study aims to investigate the methods to deal with hepatic venous system hemorrhage and carbon dioxide gas embolization based on author's institutional experience and relevant literature. We retrospectively analyzed the data of 60 patients who received laparoscopic anatomical hepatectomy of hepatic vein approach for HCC. For patients with intraoperative complications, corresponding treatments were given to cope with different complications. After the operation, combined with clinical experience and literature, we summarized and discussed the good treatment methods in the face of such situations so that minimize the harm to patients as much as possible.

Commentary: Comparison of newer hand-held ultrasound devices for post-dive venous gas emboli quantification to standard echocardiography.

We read with interest the study by Karimpour et al. (2022) comparing two new portable devices to standard echography on the task of Venous Gas Embolism (VGE) detection in scuba divers. In operating conditions of open water dives, the authors compared portable 2D echograph Butterfly iQ and Doppler ultrasound device O'Dive to a 2D echograph Vivid Q currently used for VGE detection in research. There are however several important aspects of the study that need to be considered. To evaluate monitoring difficulty with each device in operating conditions the reader would need (i) 39 the total number of dives that authors attempted to monitor, (ii) the number of dives successfully 40 monitored at least once with at least one device, (iii) the number of VGE scores obtained with each 41 device, (iv) the number of dives with a full set of measurements for each device. Moreover, it would 42 be pertinent to report if for some divers the monitoring was complicated or impossible due to some 43 physiological characteristics. Unfortunately, the only information about monitored dives and divers 44 provided was the number of subjects enrolled in the study. 45The authors excluded from analysis VGE scores from devices when a paired measurement from other

Massive gaseous embolism during cardiopulmonary resuscitation for massive hemoptysis in a COVID-19-associated pulmonary aspergillosis.

Massive gaseous embolism during cardiopulmonary resuscitation for massive hemoptysis in a COVID-19-associated pulmonary aspergillosis.

Alda-1 ameliorates air embolism-induced acute lung injury.

Evidence suggests that aldehyde dehydrogenase 2 (ALDH2) offers protection against damage caused by oxidative stress in diverse rodent models. Nonetheless, the effect of Alda-1, a compound that activates ALDH2, on acute lung injury (ALI) induced by air embolism (AE) remains unclear. The objective of this study was to explore the protective effects of Alda-1 in ALI induced by AE. A rat model of in situ isolated perfused lung was established to investigate AE-induced ALI. Air was infused into the pulmonary artery at 0.25mL/min for 1minute. Before inducing AE, different doses (10, 20, or 30mg/kg) of Alda-1 were given through intraperitoneal injection. Pathological changes in lung tissue were assessed using hematoxylin-eosin staining. We performed Western blot analysis to assess the protein levels of ALDH2,4-hydroxy-trans-2-nonenal (4-HNE), Bcl-2, caspase-3, phosphatidylinositol 3-kinase (PI3K), Akt, IκB-α, and nuclear NF-κB. Notably, AE results were demonstrated as harmful to the lungs, which is evidenced by intensified lung edema and disruption of lung tissue structure. Furthermore, AE caused a decrease in ALDH2 expression, increased accumulation of 4-HNE and MDA, infiltration of neutrophils, increased production of inflammatory cytokines, apoptosis, and upregulation of the PI3K/Akt and NF-κB signaling pathways within the lungs. Administration of a 20mg/kg dose of Alda-1 alleviated the detrimental effects induced by AE. Alda-1 shows promise in mitigating AE-induced ALI, possibly through the upregulation of ALDH2 expression and suppression of the PI3K/Akt and NF-κB signaling pathways. Further research is warranted to validate these findings and to explore their translational potential in human subjects.

Arterial gas embolism in a breath-hold diver

An arterial gas embolism (AGE) is a potentially fatal complication of scuba diving that is related to insufficient exhalation during ascent. During breath-hold diving, an arterial gas embolism is unlikely because the volume of gas in the lungs generally cannot exceed the volume at the beginning of the dive. However, if a diver breathes from a gas source at any time during the dive, they are at risk for an AGE or other pulmonary overinflation syndromes (POIS). In this case report, a breath-hold diver suffered a suspected AGE due to rapidly ascending without exhalation following breathing from an air pocket at a depth of approximately 40 feet.

Case report of CT-guided lung biopsy complicated by air embolism

Rationale: Cerebral arterial air embolism is a rare but potentially fatal complication of Computed Tomography (CT)-guided lung biopsy. Hyperbaric oxygen (HBO2) is the first line of treatment for arterial gas embolism and needs to be administered immediately after the event. Early HBO2 can reduce the mortality rate of cerebrovascular air embolism. Patient concerns: A 65-year-old woman was diagnosed with a pulmonary nodule with a diameter of approximately 0.8 cm in the right lower lung. The patient developed consciousness, convulsions, and arrhythmia after CT-guided lung biopsy. Diagnosis: Cranial CT revealed arborizing/linearly distributed gas in the right temporal, parietal, and occipital lobes and left frontal and parietal lobes. Chest CT showed a small amount of pneumothorax. Interventions: The patient was administered HBO2 twice and also received other medical treatments and bone flap decompressive craniectomy. Outcomes: The patient developed multiple acute cerebral infarctions and even brain herniation complicated with acute myocardial infarction. Three months after the event, the patient’s consciousness was still “open eyes coma” and GCS score was 8t points (E4VtM4). Head CT showed multiple cerebral infarctions and softening lesions. ECG showed sinus rhythm, normal range of the electrocardiogram axis, T wave change, and low voltage on the limb leads. Lessons: Cerebral arterial air embolism is a serious complication of CT-guided lung biopsy. The recommended standard HBO2 should be used as early as possible. However, too severe injury caused by severe arterial air embolism may not be significantly improved by one to two sessions of HBO2.