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Future Cardiology Jul 2017Air embolism is an uncommon, but potentially life-threatening event for which prompt diagnosis and management can result in significantly improved patient outcomes. Most... (Review)
Review
Air embolism is an uncommon, but potentially life-threatening event for which prompt diagnosis and management can result in significantly improved patient outcomes. Most air emboli are iatrogenic. Arterial air emboli may occur as a complication from lung biopsy, arterial catheterization or cardiopulmonary bypass. Immediate management includes placing the patient on high-flow oxygen and in the right lateral decubitus position. Venous air emboli may occur during pressurized venous infusions, or catheter manipulation. Immediate management includes placement of the patient on high-flow oxygen and in the left lateral decubitus and/or Trendelenburg position. Hyperbaric oxygen therapy is the definitive treatment which may decrease the size of air emboli by facilitating gas reabsorption, while also improving tissue oxygenation and reducing ischemic reperfusion injury.
Topics: Arteries; Biopsy; Cardiopulmonary Bypass; Catheterization; Embolism, Air; Humans; Hyperbaric Oxygenation; Infusions, Intravenous; Medical Illustration; Patient Positioning
PubMed: 28644058
DOI: 10.2217/fca-2017-0015 -
Clinical Journal of the American... Feb 2017Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs... (Review)
Review
Given the high comorbidity in patients on hemodialysis and the complexity of the dialysis treatment, it is remarkable how rarely a life-threatening complication occurs during dialysis. The low rate of dialysis emergencies can be attributed to numerous safety features in modern dialysis machines; meticulous treatment and testing of the dialysate solution to prevent exposure to trace elements, toxins, and pathogens; adherence to detailed treatment protocols; and extensive training of dialysis staff to handle medical emergencies. Most hemodialysis emergencies can be attributed to human error. A smaller number are due to rare idiosyncratic reactions. In this review, we highlight major emergencies that may occur during hemodialysis treatments, describe their pathogenesis, offer measures to minimize them, and provide specific interventions to prevent catastrophic consequences on the rare occasions when such emergencies arise. These emergencies include dialysis disequilibrium syndrome, venous air embolism, hemolysis, venous needle dislodgement, vascular access hemorrhage, major allergic reactions to the dialyzer or treatment medications, and disruption or contamination of the dialysis water system. Finally, we describe root cause analysis after a dialysis emergency has occurred to prevent a future recurrence.
Topics: Azotemia; Embolism, Air; Emergencies; Equipment Failure; Hemolysis; Hemorrhage; Humans; Hypersensitivity; Needles; Renal Dialysis; Root Cause Analysis; Water Supply
PubMed: 27831511
DOI: 10.2215/CJN.05260516 -
American Journal of Kidney Diseases :... May 2021Since maintenance hemodialysis (HD) first became available in the United States in 1962, there has been tremendous growth in the population of patients with kidney... (Review)
Review
Since maintenance hemodialysis (HD) first became available in the United States in 1962, there has been tremendous growth in the population of patients with kidney failure. HD has become a routine treatment carried out in outpatient clinics, hospitals, nursing facilities, and in patients' homes. Although it is a complex procedure, HD is quite safe. Serious complications are uncommon due to the use of modern HD machines and water treatment systems as well as the development of strict protocols to monitor various aspects of the HD treatment. The practicing nephrologist must be knowledgeable about life-threatening complications that can occur during HD and be able to recognize, manage, and prevent them. This installment in the AJKD Core Curriculum in Nephrology reviews the pathogenesis, management, and prevention of 9 HD emergencies. The HD emergencies covered include dialyzer reactions, dialysis disequilibrium syndrome, uremic/dialysis-associated pericarditis, air embolism, venous needle dislodgement, vascular access hemorrhage, hemolysis, dialysis water contamination, and arrhythmia episodes.
Topics: Arrhythmias, Cardiac; Brain Edema; Decontamination; Dialysis Solutions; Embolism, Air; Emergencies; Fluid Shifts; Hemolysis; Hemorrhage; Humans; Hypersensitivity; Kidney Failure, Chronic; Kidneys, Artificial; Needles; Nephrology; Pericarditis; Prosthesis Failure; Renal Dialysis; Sterilization; Uremia; Water Purification
PubMed: 33771393
DOI: 10.1053/j.ajkd.2020.11.024 -
The New England Journal of Medicine Mar 2022
Review
Topics: Decompression Sickness; Embolism, Air; Humans
PubMed: 35353963
DOI: 10.1056/NEJMra2116554 -
Frontiers in Immunology 2023Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical... (Review)
Review
Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to and studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition.
Topics: Humans; Embolism, Air; Thromboinflammation; Inflammation; Thrombosis; Iatrogenic Disease
PubMed: 37795086
DOI: 10.3389/fimmu.2023.1230049 -
Stroke Jul 2019
Topics: Aged, 80 and over; Blood Pressure; Cerebrovascular Disorders; Embolism, Air; Female; Heart Rate; Humans; Tomography, X-Ray Computed
PubMed: 31164070
DOI: 10.1161/STROKEAHA.119.025340 -
Hemodialysis International.... Apr 2017During preparation of the hemodialysis (HD) extracorporeal circuit (ECC) a priming solution is used to remove air from the tubes and dialyzer. Ultra sound techniques... (Review)
Review
During preparation of the hemodialysis (HD) extracorporeal circuit (ECC) a priming solution is used to remove air from the tubes and dialyzer. Ultra sound techniques have verified micro embolic signals (MES) in the ECC that may derive from clots or gas embolies. In vitro studies could clarify that embolies of air develop within the ECC and also pass the safety systems such as air traps and enter the venous line that goes into the patient. Clinical studies have confirmed the presence of MES within the ECC that pass into the return-venous-line during conventional HD without inducing an alarm. In addition, studies confirmed that such MES were present within the AV fistula and subclavian vein, but also detected within the carotid artery. Autopsy studies revealed the presence of gas embolies surrounded by clots within the lung but also brain and myocardial tissue. This review will focus on how the MES develop and measures of how the exposure can be limited.
Topics: Embolism, Air; Humans; Renal Dialysis
PubMed: 27576675
DOI: 10.1111/hdi.12474 -
Neurocritical Care Feb 2023Arterial cerebral air embolism (CAE) is an uncommon but potentially catastrophic event. Patients can present with focal neurologic deficits, seizures, or coma. They may... (Review)
Review
BACKGROUND
Arterial cerebral air embolism (CAE) is an uncommon but potentially catastrophic event. Patients can present with focal neurologic deficits, seizures, or coma. They may be treated with hyperbaric oxygen therapy. We review the causes, radiographic and clinical characteristics, and outcomes of patients with CAE.
METHODS
We performed a retrospective chart review via an existing institutional database at Mayo Clinic to identify patients with arterial CAE. Demographic data, clinical characteristics, and diagnostic studies were extracted and classified on predefined criteria of diagnostic confidence, and descriptive and univariate analysis was completed.
RESULTS
Fifteen patients met criteria for inclusion in our study. Most presented with focal deficits (80%) and/or coma (53%). Seven patients (47%) had seizures, including status epilepticus in one (7%). Five presented with increased muscle tone at the time of the event (33%). Computed tomography (CT) imaging was insensitive for the detection of CAE, only identifying free air in 4 of 13 who underwent this study. When obtained, magnetic resonance imaging typically showed multifocal areas of restricted diffusion. Six patients (40%) were treated with hyperbaric oxygen therapy. Age, Glasgow Coma Scale score at nadir, and use of hyperbaric oxygen therapy were not associated with functional outcome at 1 year in our cohort. Twenty-six percent of patients had a modified Rankin scale score of 0 one year after the event, and functional improvement over time was common after discharge.
CONCLUSIONS
A high index of clinical suspicion is needed to identify patients with CAE because of low sensitivity of free air on CT imaging and nonspecific clinical presentation. Acute alteration of consciousness, seizures, and focal signs occur frequently. Because improvement over time is possible even among patients with severe presentation, early prognostication should be approached with caution.
Topics: Humans; Coma; Embolism, Air; Retrospective Studies; Tomography, X-Ray Computed; Seizures; Hyperbaric Oxygenation
PubMed: 36627433
DOI: 10.1007/s12028-022-01664-3 -
Emergency Medicine Clinics of North... May 2017Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are rare but serious afflictions that can result from compressed gas... (Review)
Review
Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are rare but serious afflictions that can result from compressed gas diving exposures. Risk is primarily determined by the pressure-time profile but is influenced by several factors. DCI can present idiosyncratically but with a wide range of neurologic symptoms. Examination is critical for assessment in the absence of diagnostic indicators. Many conditions must be considered in the differential diagnosis. High-fraction oxygen breathing provides first aid but definitive treatment of DCI is hyperbaric oxygen.
Topics: Anticoagulants; Decompression Sickness; Diving; Embolism, Air; First Aid; Humans; Hyperbaric Oxygenation; Neurologic Examination; Physical Examination
PubMed: 28411929
DOI: 10.1016/j.emc.2016.12.002 -
Schweizer Archiv Fur Tierheilkunde Sep 2017Intravenous catheterization is a necessity for continuous administration of intravenous fluids and for intermittent intravenous access to avoid discomfort and potential... (Review)
Review
Intravenous catheterization is a necessity for continuous administration of intravenous fluids and for intermittent intravenous access to avoid discomfort and potential complications of repeated needle insertions into the vein. Intravenous catheterization is commonly performed and well tolerated in horses, but catheter associated complications have been reported. The most commonly reported complication is thrombophlebitis, but others such as venous air embolism, exsanguination and catheter fragmentation may also occur. This article aims to review clinical signs, pathogenesis, diagnosis, therapy, risk factors and prevention of common catheter associated complications.
Topics: Animals; Catheterization, Peripheral; Embolism, Air; Exsanguination; Horse Diseases; Horses; Prognosis; Risk Factors; Thrombophlebitis; Vascular Access Devices
PubMed: 28952957
DOI: 10.17236/sat00126