Oxygen Therapy with High-Flow Nasal Cannula as an Effective Treatment for Perioperative Pneumocephalus: Case Illustrations and Pathophysiological Review

Document Type

Article

Abstract

Pneumocephalus (PNC) is a condition in which when air is trapped inside the intracranial vault. The causes are varied, but include trauma and intracranial surgery. Treatment of PNC typically consists of augmenting patient oxygenation with the attempt of washing out pulmonary nitrogen, creating a gradient in which nitrogen in the intracranial air bubble diffuses out of the lungs via the blood. Though several high flow methods have been tested, the ideal mode of oxygenation has not fully been investigated. Here we present 3 cases of post-operative PNC who we felt were symptomatic from PNC. With administration of high-flow nasal cannula (HFNC), all patients improved both clinically and radiographically within a few hours, faster than in both anecdotal experience and published trials. Due to its steady FiO2 administration, positive pressure, comfort, and low side-effect profile, HFNC may be the ideal mode of oxygen delivery in PNC. We present a review of the physiology of PNC and the characteristics of several oxygen delivery systems to build a case for HFNC in this disease process.

Medical Subject Headings

Aged; Cannula; Craniotomy (adverse effects); Female; Humans; Male; Middle Aged; Oxygen Inhalation Therapy (instrumentation, methods); Pneumocephalus (etiology, physiopathology, therapy); Postoperative Complications (etiology, therapy)

Publication Date

12-1-2018

Publication Title

Neurocritical care

E-ISSN

1556-0961

Volume

29

Issue

3

First Page

366

Last Page

373

PubMed ID

28932993

Digital Object Identifier (DOI)

10.1007/s12028-017-0464-x

Link to Full Text

Share

COinS