IF PORTAL VENOUS AIR IS DETECTED, DO PATIENTS REQUIRE HYPERBARIC OXYGEN THERAPY?
The management of patients with portal venous gas following H2O2 ingestion is controversial and has not been established. Hyperbaric oxygen therapy involves increasing the ambient pressure by several atmospheres inside a specially designed chamber—the same therapy used for diving-related bubble injury.
Hyperbaric therapy increases the amount of oxygen that can be dissolved in the blood, thereby decreasing bubble formation and allowing transport of dissolved oxygen to the lungs, where it can be exhaled. Some patients with portal venous air experience significant pain and portal venous hypertension, which may respond rapidly to this therapy.10
Based on available literature, hyperbaric therapy is reasonable for patients with significant abdominal pain and portal venous air following H2O2 ingestion; less controversial is the role of hyperbaric therapy in those with cerebral air embolism. Multiple case reports of patients with significant neurologic findings demonstrate resolution of symptoms following hyperbaric therapy.6
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