title: Fatal brain gas embolism during non-invasive positive pressure ventilation.
abstract: Gas embolism is a dreaded complication following invasive medical procedures, traumatic lung injury and decompression accidents. We report a case of fatal gas embolism following the use of non-invasive ventilation (NIV) with bilevel positive airway pressure (BiPAP). The patient initially underwent left bronchial artery embolisation for massive haemoptysis in the context of severe tuberculotic sequels. Under NIV and after heavy coughing he became hemiparetic and his level of consciousness suddenly dropped. Computed tomography of the brain showed multiple air embolism and ischaemic lesions were confirmed by magnetic resonance imaging. Echocardiographic investigations showed no intracardiac defect. Vasculo-pulmonary abnormalities in the context of heavy coughing and non-invasive ventilation may have played a major role in the occurrence of this event. New neurological events in a patient with tuberculotic sequels or any known vascular pulmonary abnormalities and NIV should raise the suspicion of brain gas embolism.
authors.affiliation: Geneva University Hospitals (HUG), Internal Medicine, Geneva 14, Switzerland, 1211. rivara-mangeat-claire-benedicte@diogenes.hcuge.ch
authors.forename: Claire B
authors.initials: CB
authors.lastname: Rivara
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Chevrolet
authors.forename: Yvan
authors.initials: Y
authors.lastname: Gasche
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Charbonney
mesh_terms: D000368:Aged; D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D003371:Cough / Q000150:complications*; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology*; D004621:Embolization, Therapeutic; D017809:Fatal Outcome; D006469:Hemoptysis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D011859:Radiography; D014397:Tuberculosis, Pulmonary / Q000150:complications