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Opinions/Hypotheses |

Is Emergency Thoracotomy Always the Most Appropriate Immediate Intervention for Systemic Air Embolism After Lung Trauma?*

Anthony M.-H. Ho, MD
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*From the Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.

Correspondence to: Anthony Ho, MD, Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, PRC; e-mail: hoamh@hotmail.com



Chest. 1999;116(1):234-237. doi:10.1378/chest.116.1.234
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Abbreviations: PPV = positive pressure ventilation; SAE = systemic air (or gas) embolism

Lung trauma involving laceration of air passages, lung parenchyma, and blood vessels may result in direct communication among these injured entities. Systemic air (or gas) embolism (SAE) occurs when gas enters pulmonary veins—the result of low pulmonary venous pressure (as in hypovolemia) or increased airway pressure (as in positive pressure ventilation [PPV], coughing, or tension pneumothorax), or both. Pulmonary venous gas embolizes to the heart and to the coronary and cerebral arteries with catastrophic consequences. Although iatrogenic SAE from therapeutic pneumothorax, thoracentesis, lung resection, and biopsy17 has been shown to occur for many decades, it was not until 1973 that a description of this clinical condition as a sequela of lung trauma was first published.8

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