What is a diffuse gas embolism? Is it very different from pulmonary embolism? How dangerous is this type of blockage and how does it relate to Covid-19?
Suspicions of widespread gas embolism grew after the medical report on the case of actor Paulo Gustavo, 42, mentioned this term and indicated that “unfortunately, the current clinical situation is very unstable and dangerous.”
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The memo, issued on Monday (3), states that “there has been a marked deterioration in the level of consciousness and vital signs” by Paulo Gustavo and indicates that “the new tests showed that there was a diffuse invasive embolism, including the central nervous system. “.
BBC News Brazil heard pulmonologists and condensers answer key questions about airway embolism.
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Gas embolism occurs when air bubbles enter the circulation (where, under normal circumstances, only blood should circulate), causing obstructions.
“In gas embolism, air bubbles enter the circulation, obstructing blood circulation, and lead to a lack of oxygen in the area, which is essential for cells to survive,” explains intensive physician Jose Albany de Oak.
Thus, an invasive embolism differs from an obstruction caused by a blood clot, in that an artery or vein obstruction is caused by a thrombus.
Pulmonologist Arthur Feltrine notes that thromboembolism is more common and has simpler treatment: anticoagulants, which are able to dissolve a clot and restore circulation.
How does this air enter the blood circulation?
The medical note states that the gas embolism of the actor Gustavo Gustavo occurred “as a result of the lateral bronchial venous fistula”.
“Fistula is like communication due to a ruptured membrane, in two structures – in this case, the vein and the bronchioles, which are two structures that do not communicate in a normal way,” explains Felterin. “With this rupture of the membrane, the gas content leaves the bronchioles and goes into the vein. Unfortunately, this gas was not only in the lung, but spread.”
The doctors interviewed by BBC News Brazil did not go into details about the situation of the humorist, as they are not involved in the care of Paulo Gustavo.
Given the cases of gas obstruction in general, according to doctors, correcting this fistula would be a way to treat it.
Pulmonologist Patricia Canto, from Fiucruz, says the main treatment for gas embolism is “to locate this point as quickly as possible and correct this point where there is an escape of air into the venous system”, in addition to life support measures.
Filtrine recalls that unlike a blockage caused by a thrombus, there is no drug that is able to remove gases from the circulation.
“The treatment is to correct this fistula, but it often needs surgery, and patients are often unable to undergo this procedure, because they are unstable. With a mechanical ventilator, cardiopulmonary bypass, there is no way to stop these devices to correct the fistula.”
How severe is the spread of gas embolism?
Doctors say that the spread of air through the bloodstream and affected organs are the main factors determining the severity of the condition.
“It could be localized gas embolism, affecting only one organ. Or it could be a more sensitive situation with a higher death rate, which is a diffuse gas embolism – that is, it starts in one organ and spreads the gas to other organs,” he says. “If it spreads to the lungs, heart and especially the brain, it greatly increases the death rate.”
What has to do with Covid?
Doctors suggest that gas embolism is not related to Covid itself, but rather to the treatments often necessary to deal with complications related to the disease.
Patricia Canto notes that the more mechanical ventilation a patient needs, the greater the chance of complications.
“The gas blockage is often the result of the complication of mechanical ventilation, cardiopulmonary bypass,” says Felterin, “which is necessary in severe cases of Covid.”
“In other words, Covid is not causing (a gas blockage), but rather a result of the devices that we need to use in severe cases of disease,” the doctor says.