title: Delayed systemic air embolism in a child with severe blunt chest trauma treated with high-frequency oscillatory ventilation.
abstract: OBJECTIVE
  Trauma is the leading cause of death in children over one year of age. Even with optimal field care, blunt chest trauma with hemoptysis is a potentially fatal injury due to exsanguination or arterial air embolism. Most often, cardiovascular collapse that is unresponsive to therapy develops shortly after endotracheal intubation and initiation of positive pressure ventilation. We present a case of arterial air embolism after blunt chest trauma that manifested atypically late, i.e., one hour after initiation of positive pressure ventilation.
  
  
  METHODS
  A 13-yr-old Caucasian boy was admitted to the emergency room after he had been run over by a car. While lung protective ventilation, including high frequency oscillatory ventilation, was performed, an alveolar to pulmonary venous fistula developed. Although the complication was diagnosed quickly, involvement of the cerebral and coronary arteries resulted in irreversible cerebral damage and fatal hemodynamic collapse. Necropsy confirmed severe damage of the right pulmonary lower lobe with involvement of the pulmonary vessels.
  
  
  CONCLUSIONS
  Patients with blunt chest trauma and hemoptysis present a diagnostic dilemma with limited therapeutic options.
authors: Department of Intensive Care Medicine, HELIOS Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany. joerg.brederlau@helios-kliniken.de
authors: Jörg
authors: J
authors: Brederlau
authors: Ralf M
authors: RM
authors: Muellenbach
authors: Christian
authors: C
authors: Wunder
authors: Ulrich
authors: U
authors: Schwemmer
authors: Markus
authors: M
authors: Kredel
authors: Norbert
authors: N
authors: Roewer
authors: Thomas
authors: T
authors: Wurmb
mesh_terms: D000293:Adolescent; D004618:Embolism, Air / Q000209:etiology*; D006469:Hemoptysis / Q000150:complications; D006612:High-Frequency Ventilation; D006801:Humans; D008297:Male; D013898:Thoracic Injuries / Q000150:complications*; D014949:Wounds, Nonpenetrating / Q000150:complications*