To the Editor:-In her interesting article about complications of endobronchial laser treatment, Dullye et al. describe three cases of gas embolization. The underlining pathophysiologic mechanism is similar to gas emboli resulting from barotrauma in diving accidents. Because of high pressure, air is forced to enter into the pulmonary vasculature through ruptured lung tissue. Bubbles in the coronary arteries or the central nervous system can be life-threatening or result in prolonged neurologic deficits. Rapid repressurization according to the US-Navy Dive Table 6A can be a life-saving procedure and is described to improve especially the neurologic outcome even if treatment is delayed up to 30 h. Limiting factors for hyperbaric therapy in critical ill patients are the access to an adequately equipped pressure chamber and concomitant diseases like chronic obstructive pulmonary disease, untreated pneumothorax, or severe seizure disorders, which may be exacerbated when oxygen is breathed under pressure. In my opinion, hyperbaric therapy should be considered as a therapeutic option, even if the gas embolus is not the result of a classical diving accident.
Sebastian Schulz-Stubner, M.D.
Neurather Str 2f; Grevenbroich, D-41515; Germany
(Accepted for publication September 9, 1997.)