J Neurocrit Care.  2019 Dec;12(2):98-101. 10.18700/jnc.190095.

Oxygen supplementation via high-flow nasal cannula is an effective treatment for pneumocephalus

• Lee DS
• Cha JK
• Lee DH
• Byun KS
• Jeong JH

• KMID: 2470471
• DOI: http://doi.org/10.18700/jnc.190095

Abstract

BACKGROUND
Oxygen supplementation through a high-flow nasal cannula (HFNC) is a powerful technique that promotes the absorption of air by delivering high concentrations of oxygen to patients who are not intubated, and may be a viable treatment option for pneumocephalus.
CASE REPORT
A 75-year-old female presented in a stuporous state. She had received an epidural injection due to back pain 2 hours ago. Non-contrast brain computed tomography revealed a pneumocephalus at the interhemispheric fissure and the prepontine cistern. HFNC oxygen therapy at 60 L/min with a fraction of inspired oxygen of 1 was started. By the next morning, her mental status had recovered and a repeat brain computed tomography 15 hours later revealed complete absorption of the pneumocephalus.
CONCLUSION
Supplemental high oxygen via HFNC can be successfully used in patients with pneumocephalus who are not intubated and mechanically ventilated.

Keyword

Pneumocephalus; High-flow nasal cannula; Oxygen therapy

MeSH Terms

Absorption
Aged
Back Pain
Brain
Catheters*
Female
Humans
Injections, Epidural
Oxygen*
Pneumocephalus*
Stupor
Oxygen

Figure

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  Fig. 1. (A) Non-contrast brain computed tomography revealing pneumocephalus at the interhemispheric fissure and the prepontine cistern (white arrows). (B) Diffusion-weighted image and (C) gradient-echo also reveal pneumocephalus. (D) Follow-up brain computed tomography 15 hours later demonstrates the complete absorption of the pneumocephalus.

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  Fig. 2. High-flow nasal cannula oxygen therapy at 60 L/min, with fraction of inspired oxygen (FiO2) of 1, was started.

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