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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 -
Anesthesiology Jan 2007Vascular air embolism is a potentially life-threatening event that is now encountered routinely in the operating room and other patient care areas. The circumstances... (Review)
Review
Vascular air embolism is a potentially life-threatening event that is now encountered routinely in the operating room and other patient care areas. The circumstances under which physicians and nurses may encounter air embolism are no longer limited to neurosurgical procedures conducted in the "sitting position" and occur in such diverse areas as the interventional radiology suite or laparoscopic surgical center. Advances in monitoring devices coupled with an understanding of the pathophysiology of vascular air embolism will enable the physician to successfully manage these potentially challenging clinical scenarios. A comprehensive review of the etiology and diagnosis of vascular air embolism, including approaches to prevention and management based on experimental and clinical data, is presented. This compendium of information will permit the healthcare professional to rapidly assess the relative risk of vascular air embolism and implement monitoring and treatment strategies appropriate for the planned invasive procedure.
Topics: Catheterization, Central Venous; Echocardiography, Transesophageal; Embolism, Air; Humans; Positive-Pressure Respiration; Posture; Ultrasonography, Doppler
PubMed: 17197859
DOI: 10.1097/00000542-200701000-00026 -
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 -
Journal of Clinical Monitoring and... 2000Pulmonary air embolism is a well-known consequence of surgery, trauma, diving, and aviation. This article reviews the physiological effects, means of detection and... (Review)
Review
Pulmonary air embolism is a well-known consequence of surgery, trauma, diving, and aviation. This article reviews the physiological effects, means of detection and methods of prevention and treatment of pulmonary air embolism. The primary physiological effects are elevated pulmonary artery pressures, increased ventilation-perfusion inhomogeneity, and right ventricular failure. The degree of physiological impairment depends on the volume of gas entrained, the rate of entrainment, the type of gas entrained, and the position of the patient when the embolism occurs. Transesophageal echocardiography is the most sensitive method of detection, but it is invasive. Precordial Doppler ultrasound is almost as sensitive and poses no risk to the patient. End-tidal carbon dioxide monitoring is used on all patients and is a moderately sensitive method of detection, which is useful during surgeries that have a low incidence of air embolism. For high-risk procedures, precordial Doppler ultrasound and a multi-orifice right heart catheter should be used to detect and treat pulmonary air embolism. Prevention measures include volume expansion, careful positioning, positive end-expiratory pressure, military anti-shock trousers, and jugular venous compression. Treatment of pulmonary air embolism includes flooding the surgical site with saline, controlling sites of air entry, repositioning the patient with the surgical site below the right atrium, aspiration of air from a central venous catheter, cessation of inhaled nitrous oxide, and resuscitation with oxygen, intravenous fluids, and inotropic agents. Some hypotheses on the effects of air in the pulmonary vasculature and investigational treatment options are discussed.
Topics: Aerospace Medicine; Cardiac Catheterization; Diagnosis, Differential; Embolism, Air; Gravity Suits; Humans; Oxygen Inhalation Therapy; Posture; Pulmonary Embolism; Ultrasonography, Doppler
PubMed: 12580220
DOI: 10.1023/a:1011455701892 -
Journal of Critical Care Dec 2017To narratively review published information on prevention, detection, pathophysiology, and appropriate treatment of vascular air embolism (VAE). (Review)
Review
PURPOSE
To narratively review published information on prevention, detection, pathophysiology, and appropriate treatment of vascular air embolism (VAE).
MATERIALS AND METHODS
MEDLINE, SCOPUS, Cochrane Central Register and Google Scholar databases were searched for data published through October 2016. The Manufacturer and User Facility Device Experience (MAUDE) database was queried for "air embolism" reports (years 2011-2016).
RESULTS
VAE may be introduced through disruption in the integrity of the venous circulation that occurs during insertion, maintenance, or removal of intravenous or central venous catheters. VAE impacts pulmonary circulation, respiratory and cardiac function, systemic inflammation and coagulation, often with serious or fatal consequences. When VAE enters arterial circulation, air emboli affect cerebral blood flow and the central nervous system. New medical devices remove air from intravenous infusions. Early recognition and treatment reduce the clinical sequelae of VAE. An organized team approach to treatment including clinical simulation can facilitate preparedness for VAE. The MAUDE database included 416 injuries and 95 fatalities from VAE. Data from the American Society of Anesthesiologists Closed Claims Project showed 100% of claims for VAE resulted in a median payment of $325,000.
CONCLUSIONS
VAE is an important and underappreciated complication of surgery, anesthesia and medical procedures.
Topics: Anesthesia; Animals; Arteries; Catheterization, Central Venous; Disease Models, Animal; Early Diagnosis; Embolism, Air; Humans; Infusions, Intravenous; Patient Safety; Postoperative Complications; Veins
PubMed: 28802790
DOI: 10.1016/j.jcrc.2017.08.010 -
CJEM May 2023
Topics: Humans; Embolism, Air; Tomography, X-Ray Computed; Biopsy, Needle
PubMed: 37142857
DOI: 10.1007/s43678-023-00506-1 -
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 -
The American Journal of the Medical... Mar 2022
Topics: Dentistry; Embolism, Air; Humans
PubMed: 34757040
DOI: 10.1016/j.amjms.2021.10.010 -
Medicina (Kaunas, Lithuania) 2003Venous air embolism is the entry of air into the venous system as a consequence of trauma or iatrogenic complications (especially central venous cannulation or... (Review)
Review
Venous air embolism is the entry of air into the venous system as a consequence of trauma or iatrogenic complications (especially central venous cannulation or pressurized intravenous infusion systems). It also can occur following the surgical procedures. Venous air embolism results in right ventricular dysfunction and pulmonary injury. In this review article various causes, frequency, pathophysiology, clinical features, diagnosis, treatment, outcome and prevention of venous air embolism are discussed.
Topics: Adult; Catheterization, Central Venous; Child; Embolism, Air; Humans; Hyperbaric Oxygenation; Infusions, Intravenous; Oxygen Inhalation Therapy; Ventricular Dysfunction, Right
PubMed: 12738914
DOI: No ID Found -
Kidney International Feb 2020
Topics: Catheters, Indwelling; Embolism, Air; Humans; Peritoneal Dialysis; Postoperative Complications
PubMed: 31980081
DOI: 10.1016/j.kint.2019.09.009