Cerebral gas embolism in a case of Influenza a-associated acute respiratory distress syndrome treated with high-frequency oscillatory ventilation

A 22-year-old obese asthmatic woman with Influenza A [H1 N1]-associated acute respiratory distress syndrome died from cerebral artery gas emboli with massive cerebral infarction while being treated with High-Frequency Oscillatory Ventilation in the absence of a right to left intracardiac shunt. We review and briefly discuss other causes of systemic gas emboli [SGE]. We review proposed mechanisms of SGE, their relation to our case, and how improved understanding of the risk factors may help prevent SGE in positive pressure ventilated patients