Skip to main content
Erschienen in: European Journal of Applied Physiology 3/2013

01.03.2013 | Original Article

Transient ischemic attacks from arterial gas embolism induced by glossopharyngeal insufflation and a possible method to identify individuals at risk

verfasst von: Tomas A. Schiffer, Peter Lindholm

Erschienen in: European Journal of Applied Physiology | Ausgabe 3/2013

Einloggen, um Zugang zu erhalten

Abstract

Breath-hold divers report transient, severe neurological symptoms that could be caused by arterial gas embolism after glossopharyngeal insufflation. This technique is often used to overinflate the lungs and stretch the chest prior to breath-holding and can increase the transpulmonary pressure to around 7–8 kPa, so introducing risk of pulmonary barotrauma. Airway pressure, blood pressure and static spirometry (nitrogen dilution) were measured simultaneously in ten subjects attempting to identify individuals at risk. Compared to baseline, total lung capacity (TLC) after glossopharyngeal insufflation increased by 19 % along with increased vital capacity (23 %) and residual volume (6 %) (P < 0.05), while mean relaxed airway pressure (P aw) at TLC increased from 3.62 ± 0.93 to 7.26 ± 2.04 kPa as a result of performing glossopharyngeal insufflation (P = 0.0001). Blood pressure fell during glossopharyngeal insufflation and attained relaxed airway pressure correlated positively to baseline mean arterial pressure in the subjects. Two of the subjects had glossopharyngeal insufflation-related accidents before the study and two subjects (with the highest P aw during GI; 9 and 10.3 kPa respectively) suffered glossopharyngeal insufflation-related accidents within 6 months after our study, with one suffering a non-fatal drowning accident. The principal finding of this study was that some subjects were able to use GI to reach P aw high enough to suggest a risk of pulmonary barotrauma, while other subjects would lose consciousness due to hypotension while still within safe limits of pulmonary pressure. This mechanism could offer an alternative explanation to drowning in breath-hold divers, and indicates that glossopharyngeal insufflation should be avoided or done with extreme caution.
Literatur
Zurück zum Zitat Andersson JP, Liner MH, Jonsson H (2009) Asystole and increased serum myoglobin levels associated with ‘packing blackout’ in a competitive breath-hold diver. Clin Physiol Funct Imaging 29:458–461PubMedCrossRef Andersson JP, Liner MH, Jonsson H (2009) Asystole and increased serum myoglobin levels associated with ‘packing blackout’ in a competitive breath-hold diver. Clin Physiol Funct Imaging 29:458–461PubMedCrossRef
Zurück zum Zitat Batinic T, Utz W, Breskovic T, Jordan J, Schulz-Menger J, Jankovic S, Dujic Z, Tank J (2011) Cardiac magnetic resonance imaging during pulmonary hyperinflation in apnea divers. Med Sci Sports Exerc 43:2095–2101PubMedCrossRef Batinic T, Utz W, Breskovic T, Jordan J, Schulz-Menger J, Jankovic S, Dujic Z, Tank J (2011) Cardiac magnetic resonance imaging during pulmonary hyperinflation in apnea divers. Med Sci Sports Exerc 43:2095–2101PubMedCrossRef
Zurück zum Zitat Benton PJ, Woodfine JD, Westwood PR (1996) Arterial gas embolism following a 1-meter ascent during helicopter escape training: a case report. Aviat Space Environ Med 67:63–64PubMed Benton PJ, Woodfine JD, Westwood PR (1996) Arterial gas embolism following a 1-meter ascent during helicopter escape training: a case report. Aviat Space Environ Med 67:63–64PubMed
Zurück zum Zitat Butler BD, Hills BA (1979) The lung as a filter for microbubbles. J Appl Physiol 47:537–543PubMed Butler BD, Hills BA (1979) The lung as a filter for microbubbles. J Appl Physiol 47:537–543PubMed
Zurück zum Zitat Chung SC, Seccombe LM, Jenkins CR, Frater CJ, Ridley LJ, Peters MJ (2010) Glossopharyngeal insufflation causes lung injury in trained breath-hold divers. Respirology 15:813–817PubMedCrossRef Chung SC, Seccombe LM, Jenkins CR, Frater CJ, Ridley LJ, Peters MJ (2010) Glossopharyngeal insufflation causes lung injury in trained breath-hold divers. Respirology 15:813–817PubMedCrossRef
Zurück zum Zitat Craig AB Jr (1976) Summary of 58 cases of loss of consciousness during underwater swimming and diving. Med Sci Sports 8:171–175PubMedCrossRef Craig AB Jr (1976) Summary of 58 cases of loss of consciousness during underwater swimming and diving. Med Sci Sports 8:171–175PubMedCrossRef
Zurück zum Zitat Dail CW, Affeldt JE, Collier CR (1955) Clinical aspects of glossopharyngeal breathing; report of use by one hundred postpoliomyelitic patients. J Am Med Assoc 158:445–449PubMedCrossRef Dail CW, Affeldt JE, Collier CR (1955) Clinical aspects of glossopharyngeal breathing; report of use by one hundred postpoliomyelitic patients. J Am Med Assoc 158:445–449PubMedCrossRef
Zurück zum Zitat Dutka AJ, Kochanek P, Hallenbeck JM, Storey JR (1988) Air embolism may cause unrecognized ischemia of the gray–white junction. Undersea Biomed Res 15:99–106PubMed Dutka AJ, Kochanek P, Hallenbeck JM, Storey JR (1988) Air embolism may cause unrecognized ischemia of the gray–white junction. Undersea Biomed Res 15:99–106PubMed
Zurück zum Zitat Dzamonja G, Tank J, Heusser K, Palada I, Valic Z, Bakovic D, Obad A, Ivancev V, Breskovic T, Diedrich A, Luft FC, Dujic Z, Jordan J (2010) Glossopharyngeal insufflation induces cardioinhibitory syncope in apnea divers. Clin Auton Res Off J Clin Auton Res Soc 20:381–384CrossRef Dzamonja G, Tank J, Heusser K, Palada I, Valic Z, Bakovic D, Obad A, Ivancev V, Breskovic T, Diedrich A, Luft FC, Dujic Z, Jordan J (2010) Glossopharyngeal insufflation induces cardioinhibitory syncope in apnea divers. Clin Auton Res Off J Clin Auton Res Soc 20:381–384CrossRef
Zurück zum Zitat Eichinger M, Walterspacher S, Scholz T, Tetzlaff R, Puderbach M, Tetzlaff K, Kopp-Schneider A, Ley S, Choe K, Kauczor HU, Sorichter S (2010) Glossopharyngeal insufflation and pulmonary hemodynamics in elite breath hold divers. Med Sci Sports Exerc 42:1688–1695PubMedCrossRef Eichinger M, Walterspacher S, Scholz T, Tetzlaff R, Puderbach M, Tetzlaff K, Kopp-Schneider A, Ley S, Choe K, Kauczor HU, Sorichter S (2010) Glossopharyngeal insufflation and pulmonary hemodynamics in elite breath hold divers. Med Sci Sports Exerc 42:1688–1695PubMedCrossRef
Zurück zum Zitat Gorman DF, Browning DM (1986) Cerebral vasoreactivity and arterial gas embolism. Undersea Biomed Res 13:317–335PubMed Gorman DF, Browning DM (1986) Cerebral vasoreactivity and arterial gas embolism. Undersea Biomed Res 13:317–335PubMed
Zurück zum Zitat Helps SC, Parsons DW, Reilly PL, Gorman DF (1990) The effect of gas emboli on rabbit cerebral blood flow. Stroke J Cereb Circ 21:94–99CrossRef Helps SC, Parsons DW, Reilly PL, Gorman DF (1990) The effect of gas emboli on rabbit cerebral blood flow. Stroke J Cereb Circ 21:94–99CrossRef
Zurück zum Zitat Jacobson FL, Loring SH, Ferrigno M (2006) Pneumomediastinum after lung packing. Undersea Hyperbaric Med J Undersea Hyperbaric Med Soc Inc 33:313–316 Jacobson FL, Loring SH, Ferrigno M (2006) Pneumomediastinum after lung packing. Undersea Hyperbaric Med J Undersea Hyperbaric Med Soc Inc 33:313–316
Zurück zum Zitat Justice C, Leach J, Edwards WS (1972) The harmful effects and treatment of coronary air embolism during open-heart surgery. Annals Thorac Surg 14:47–53CrossRef Justice C, Leach J, Edwards WS (1972) The harmful effects and treatment of coronary air embolism during open-heart surgery. Annals Thorac Surg 14:47–53CrossRef
Zurück zum Zitat Kane G, Hewins B, Grannis FW Jr (1988) Massive air embolism in an adult following positive pressure ventilation. Chest 93:874–876PubMedCrossRef Kane G, Hewins B, Grannis FW Jr (1988) Massive air embolism in an adult following positive pressure ventilation. Chest 93:874–876PubMedCrossRef
Zurück zum Zitat Lee SK, Tanswell AK (1989) Pulmonary vascular air embolism in the newborn. Arch Dis Child 64:507–510PubMedCrossRef Lee SK, Tanswell AK (1989) Pulmonary vascular air embolism in the newborn. Arch Dis Child 64:507–510PubMedCrossRef
Zurück zum Zitat Lindholm P (2007) Loss of motor control and/or loss of consciousness during breath-hold competitions. Int J Sports Med 28:295–299PubMedCrossRef Lindholm P (2007) Loss of motor control and/or loss of consciousness during breath-hold competitions. Int J Sports Med 28:295–299PubMedCrossRef
Zurück zum Zitat Lindholm P, Lundgren CE (2009) The physiology and pathophysiology of human breath-hold diving. J Appl Physiol 106:284–292PubMedCrossRef Lindholm P, Lundgren CE (2009) The physiology and pathophysiology of human breath-hold diving. J Appl Physiol 106:284–292PubMedCrossRef
Zurück zum Zitat Lindholm P, Nyren S (2005) Studies on inspiratory and expiratory glossopharyngeal breathing in breath-hold divers employing magnetic resonance imaging and spirometry. Eur J Appl Physiol 94:646–651PubMedCrossRef Lindholm P, Nyren S (2005) Studies on inspiratory and expiratory glossopharyngeal breathing in breath-hold divers employing magnetic resonance imaging and spirometry. Eur J Appl Physiol 94:646–651PubMedCrossRef
Zurück zum Zitat Lindholm P, Muth CM, Severinsen SÅ (2007) Neurological symptoms after glossopharyngeal insufflation (lungpacking) in breath hold divers suggesting cerebral arterial gas embolism. Annual meeting Undersea Hyperbaric Mediacal Society. Journal of Undersea and Hyperbaric Medical Society, Kapalua, Maui, p. 280 Lindholm P, Muth CM, Severinsen SÅ (2007) Neurological symptoms after glossopharyngeal insufflation (lungpacking) in breath hold divers suggesting cerebral arterial gas embolism. Annual meeting Undersea Hyperbaric Mediacal Society. Journal of Undersea and Hyperbaric Medical Society, Kapalua, Maui, p. 280
Zurück zum Zitat Lindholm P, Norris CM Jr, Braver JM, Jacobson F, Ferrigno M (2009) A fluoroscopic and laryngoscopic study of glossopharyngeal insufflation and exsufflation. Respir Physiol Neurobiol 167:189–194PubMedCrossRef Lindholm P, Norris CM Jr, Braver JM, Jacobson F, Ferrigno M (2009) A fluoroscopic and laryngoscopic study of glossopharyngeal insufflation and exsufflation. Respir Physiol Neurobiol 167:189–194PubMedCrossRef
Zurück zum Zitat Liner MH, Andersson JP (2010) Suspected arterial gas embolism after glossopharyngeal insufflation in a breath-hold diver. Aviat Space Environ Med 81:74–76PubMedCrossRef Liner MH, Andersson JP (2010) Suspected arterial gas embolism after glossopharyngeal insufflation in a breath-hold diver. Aviat Space Environ Med 81:74–76PubMedCrossRef
Zurück zum Zitat Loring SH, O’Donnell CR, Butler JP, Lindholm P, Jacobson F, Ferrigno M (2007) Transpulmonary pressures and lung mechanics with glossopharyngeal insufflation and exsufflation beyond normal lung volumes in competitive breath-hold divers. J Appl Physiol 102:841–846PubMedCrossRef Loring SH, O’Donnell CR, Butler JP, Lindholm P, Jacobson F, Ferrigno M (2007) Transpulmonary pressures and lung mechanics with glossopharyngeal insufflation and exsufflation beyond normal lung volumes in competitive breath-hold divers. J Appl Physiol 102:841–846PubMedCrossRef
Zurück zum Zitat Malhotra MS, Wright HC (1961) The effects of a raised intrapulmonary pressure on the lungs of fresh unchilled cadavers. J Pathol Bacteriol 82:198–202PubMedCrossRef Malhotra MS, Wright HC (1961) The effects of a raised intrapulmonary pressure on the lungs of fresh unchilled cadavers. J Pathol Bacteriol 82:198–202PubMedCrossRef
Zurück zum Zitat Neuman TS, Hallenbeck JM (1987) Barotraumatic cerebral air embolism and the mental status examination: a report of four cases. Ann Emerg Med 16:220–223PubMedCrossRef Neuman TS, Hallenbeck JM (1987) Barotraumatic cerebral air embolism and the mental status examination: a report of four cases. Ann Emerg Med 16:220–223PubMedCrossRef
Zurück zum Zitat Novalija J, Lindholm P, Loring SH, Diaz E, Fox JA, Ferrigno M (2007) Cardiovascular aspects of glossopharyngeal insufflation and exsufflation. Undersea Hyperbaric Med J Undersea Hyperbaric Med Soc Inc 34:415–423 Novalija J, Lindholm P, Loring SH, Diaz E, Fox JA, Ferrigno M (2007) Cardiovascular aspects of glossopharyngeal insufflation and exsufflation. Undersea Hyperbaric Med J Undersea Hyperbaric Med Soc Inc 34:415–423
Zurück zum Zitat Nygren-Bonnier M, Gullstrand L, Klefbeck B, Lindholm P (2007) Effects of glossopharyngeal pistoning for lung insufflation in elite swimmers. Med Sci Sports Exerc 39:836–841PubMedCrossRef Nygren-Bonnier M, Gullstrand L, Klefbeck B, Lindholm P (2007) Effects of glossopharyngeal pistoning for lung insufflation in elite swimmers. Med Sci Sports Exerc 39:836–841PubMedCrossRef
Zurück zum Zitat Rios-Tejada F, Azofra-Garcia J, Valle-Garrido J, Pujante Escudero A (1997) Neurological manifestation of arterial gas embolism following standard altitude chamber flight: a case report. Aviat Space Environ Med 68:1025–1028PubMed Rios-Tejada F, Azofra-Garcia J, Valle-Garrido J, Pujante Escudero A (1997) Neurological manifestation of arterial gas embolism following standard altitude chamber flight: a case report. Aviat Space Environ Med 68:1025–1028PubMed
Zurück zum Zitat Rudge FW (1992) Altitude-induced arterial gas embolism: a case report. Aviat Space Environ Med 63:203–205PubMed Rudge FW (1992) Altitude-induced arterial gas embolism: a case report. Aviat Space Environ Med 63:203–205PubMed
Zurück zum Zitat Schaefer KE, Allison RD, Dougherty JH Jr, Carey CR, Walker R, Yost F, Parker D (1968) Pulmonary and circulatory adjustments determining the limits of depths in breathhold diving. Science 162:1020–1023PubMedCrossRef Schaefer KE, Allison RD, Dougherty JH Jr, Carey CR, Walker R, Yost F, Parker D (1968) Pulmonary and circulatory adjustments determining the limits of depths in breathhold diving. Science 162:1020–1023PubMedCrossRef
Zurück zum Zitat Tetzlaff K, Thorsen E (2005) Breathing at depth: physiologic and clinical aspects of diving while breathing compressed gas. Clinics Chest Med 26:355–380 Tetzlaff K, Thorsen E (2005) Breathing at depth: physiologic and clinical aspects of diving while breathing compressed gas. Clinics Chest Med 26:355–380
Zurück zum Zitat Tetzlaff K, Scholz T, Walterspacher S, Muth CM, Metzger J, Roecker K, Sorichter S (2008) Characteristics of the respiratory mechanical and muscle function of competitive breath-hold divers. Eur J Appl Physiol 103:469–475PubMedCrossRef Tetzlaff K, Scholz T, Walterspacher S, Muth CM, Metzger J, Roecker K, Sorichter S (2008) Characteristics of the respiratory mechanical and muscle function of competitive breath-hold divers. Eur J Appl Physiol 103:469–475PubMedCrossRef
Zurück zum Zitat van Hulst RA, Lameris TW, Hasan D, Klein J, Lachmann B (2003) Effects of cerebral air embolism on brain metabolism in pigs. Acta Neurol Scand 108:118–124PubMedCrossRef van Hulst RA, Lameris TW, Hasan D, Klein J, Lachmann B (2003) Effects of cerebral air embolism on brain metabolism in pigs. Acta Neurol Scand 108:118–124PubMedCrossRef
Zurück zum Zitat Walterspacher S, Scholz T, Tetzlaff K, Sorichter S (2011) Breath-hold diving: respiratory function on the longer term. Med Sci Sports Exerc 43:1214–1219PubMedCrossRef Walterspacher S, Scholz T, Tetzlaff K, Sorichter S (2011) Breath-hold diving: respiratory function on the longer term. Med Sci Sports Exerc 43:1214–1219PubMedCrossRef
Metadaten
Titel
Transient ischemic attacks from arterial gas embolism induced by glossopharyngeal insufflation and a possible method to identify individuals at risk
verfasst von
Tomas A. Schiffer
Peter Lindholm
Publikationsdatum
01.03.2013
Verlag
Springer-Verlag
Erschienen in
European Journal of Applied Physiology / Ausgabe 3/2013
Print ISSN: 1439-6319
Elektronische ISSN: 1439-6327
DOI
https://doi.org/10.1007/s00421-012-2494-6

Weitere Artikel der Ausgabe 3/2013

European Journal of Applied Physiology 3/2013 Zur Ausgabe

Neu im Fachgebiet Arbeitsmedizin

Das Geschlechterparadoxon in der gesundheitlich beeinträchtigten Lebenszeit – Ende eines Mythos?

Beginnend mit den 1920er-Jahren hat sich eine Vorstellung über die Geschlechterdifferenzen in Gesundheit und Mortalität etabliert, die von Lorber und Moore in dem einprägsamen Satz: „Women get sicker, but men die quicker“, zusammengefasst wurde [ 1 …, S. 13]. Tatsächlich erscheinen vor dem Hintergrund der höheren Lebenserwartung der Frauen die Studienergebnisse zu den Geschlechterdifferenzen in der Morbidität überraschend, wonach Frauen im Durchschnitt einen schlechteren Gesundheitszustand aufweisen als Männer [

Gesunde Lebenserwartung: Ein kritischer Blick auf Nutzen und Potenziale des demographischen Gesundheitsindikators

Open Access Leitthema

Die demographische Alterung hat vielfältige gesellschaftliche Konsequenzen, deren Ausmaß wesentlich vom Gesundheitszustand der Bevölkerung abhängt. Um diesen analysieren und bewerten zu können, wurden spezielle Kennziffern entwickelt, die in …

Wie hat sich die Lebenserwartung ohne funktionelle Einschränkungen in Deutschland entwickelt? Eine Analyse mit Daten des Deutschen Alterssurveys (DEAS)

Deutschland erfährt, wie andere Hocheinkommensstaaten, aufgrund kontinuierlich rückläufiger Mortalität und niedriger Geburtenraten tiefgreifende demografische Veränderungen. Der demografische Wandel führt in Deutschland zu einem zunehmend höheren …

Hitzeschutz im Fokus der hessischen Betreuungs- und Pflegeaufsicht

Open Access Klimawandel Übersichtsartikel

Im Sommer 2023 kündigte das Bundesministerium für Gesundheit (BMG) einen nationalen Hitzeschutzplan an und forderte die Länder auf, zu prüfen, „ob die Warnstufen des [Deutschen Wetterdienstes] DWD mit der Durchführung von Akutmaßnahmen …