Venous air embolism in the sitting position in cranial neurosurgery: incidence and severity according to the used monitoring
Venous air embolism in the sitting position in cranial neurosurgery: incidence and severity according to the used monitoring
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DOI：
10.1007/s00701-016-3034-7
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发表时间：
2017-02-01
影响因子：
2.4
通讯作者：
Palmaers, Thomas
中科院分区：
文献类型：
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作者：
Guenther, Franziska;Frank, Paul;Palmaers, Thomas
关于神经外科患者的坐姿（SP）一直存在争议。SP提供了许多优点以及严重的并发症，例如通常涉及静脉空气栓塞（VAE）。对于检测VAE的最佳监测系统仍有争议。在此回顾性分析中，我们比较了208例患者。采用经食管超声心动图（TEE）或经胸多普勒（TTD）监测VAE，其中TEE监测101例，TTD监测107例，VAE发生率为23%（TTD：10%; TEE：37%），但临床相关VAE的发生率TTD组（17例VAE中的9例，53%）的潮气末二氧化碳下降超过3 mmHg，高于TEE组（62例VAE中的19例，31%）。在这个小样本中，我们发现TEE组的VAE事件更多，但临床相关VAE的发生率很少，与其他数据相当。临床相关VAE的定义尚无共识。
There is an ongoing debate about the sitting position (SP) in neurosurgical patients. The SP provides a number of advantages as well as severe complications such as commonly concerning venous air embolism (VAE). The best monitoring system for the detection of VAE is still controversial.In this retrospective analysis we compared 208 patients. Transesophageal echocardiography (TEE) or transthoracic Doppler (TTD) were used as monitoring devices to detect VAE; 101 cases were monitored with TEE and 107 with TTD.The overall incidence of VAE was 23% (TTD: 10%; TEE: 37%), but the incidence of clinically relevant VAE (drop in end-tidal carbon dioxide above 3 mmHg) was higher in the TTD group (9 out of 17 VAE, 53%) compared to the TEE group (19 out of 62 VAE, 31%). None of the patients with recorded VAE had clinically significant sequelae.In this small sample we found more VAE events in the TEE group, but the incidence of clinically relevant VAE was rare and comparable to other data. There is no consensus in the definition of clinically relevant VAE.