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Medicina Intensiva Nov 2022
Topics: Humans; Embolism, Air; Extracorporeal Circulation
PubMed: 36089513
DOI: 10.1016/j.medine.2022.07.007 -
Journal of Stroke and Cerebrovascular... Oct 2015This study aimed to investigate the clinical predictors of unfavorable prognosis in patients with venous catheter-related cerebral air embolism.
BACKGROUND
This study aimed to investigate the clinical predictors of unfavorable prognosis in patients with venous catheter-related cerebral air embolism.
METHODS
An extensive review of English literature was performed to obtain reports on cerebral air embolism published between January 1982 and July 2014 through PubMed, Journal at Ovid, and Web of Science using the Mesh terms and keywords "cerebral air embolism" and "cerebral gas embolism." Reports not fulfilling the diagnosis of cerebral air embolism and iterant articles were excluded. Demographics, clinical manifestations, and imaging findings were recorded. The air distribution on initial brain computed tomography (CT) was recorded as gyriform air (GF), cavernous sinus bubble, venous sinus bubble, and parenchymal and subarachnoid bubble. The enrolled subjects were further divided into favorable and unfavorable outcome groups for analyses.
RESULTS
Of the 33 cases enrolled, 31 had documented follow-up outcomes, including 14 with favorable and 17 with unfavorable prognoses. Patients with unfavorable outcome had older onset age (67.5 ± 15.8 versus 46.7 ± 17.0 years, P < .001), higher frequency of GF on brain CT (58.8% versus 0%, P < .01), initial consciousness disturbance (100% versus 42.9%, P < .001), and hemiparesis (100% versus 42.9%, P < .001), but lower frequency of cardiopulmonary symptoms (5.9% versus 64.3%, P < .01). In patients with central venous catheter-related cerebral air embolism, the retrograde mechanism had a tendency for worse outcomes (43.8% versus 0%, P = .023).
CONCLUSIONS
In patients with venous catheter-related cerebral air embolism, the presence of GF on brain CT imaging, old age, initial conscious disturbance, and hemiparesis may predict unfavorable outcomes.
Topics: Adult; Aged; Aged, 80 and over; Aging; Brain; Catheterization, Central Venous; Consciousness Disorders; Databases, Bibliographic; Embolism, Air; Female; Follow-Up Studies; Humans; Male; Middle Aged; Paresis; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 26219843
DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.028 -
Journal of Clinical Monitoring and... Oct 2021Neurological surgery in the semi-sitting position is linked with a pronounced incidence of venous air embolism (VAE) which can be fatal and therefore requires continuous...
Neurological surgery in the semi-sitting position is linked with a pronounced incidence of venous air embolism (VAE) which can be fatal and therefore requires continuous monitoring. Transesophageal echocardiography (TEE) provides a high sensitivity for the intraoperative detection of VAE; however, continuous monitoring with TEE requires constant vigilance by the anaesthesiologist, which cannot be ensured during the entire surgical procedure. We implemented a fully automatic VAE detection system for TEE based on a statistical model of the TEE images. In the sequence of images, the cyclic heart activity is regarded as a quasi-periodic process, and air bubbles are detected as statistical outliers. The VAE detection system was evaluated by means of receiver operating characteristic (ROC) curves using a data set consisting of 155.14 h of intraoperatively recorded TEE video and a manual classification of periods with visible VAE. Our automatic detection system accomplished an area under the curve (AUC) of 0.945 if all frames with visible VAE were considered as detection target, and an AUC of 0.990 if frames with the least severe optical grade of VAE were excluded from the analysis. Offline-review of the recorded TEE videos showed that short embolic events (≤ 2 min) may be overseen when monitoring TEE video manually. Automatic detection of VAE is feasible and could provide significant support to anaesthesiologists in clinical practice. Our proposed algorithm might possibly even offer a higher sensitivity compared to manual detection. The specificity, however, requires improvement to be acceptable for practical application. Trial Registration: German Clinical Trials Register (DRKS00011607).
Topics: Echocardiography, Transesophageal; Embolism, Air; Humans; Neurosurgical Procedures; Pilot Projects; Sitting Position
PubMed: 32809088
DOI: 10.1007/s10877-020-00568-x -
European Radiology Apr 2021To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a...
OBJECTIVES
To determine the incidence, risk factors, and prognostic indicators of symptomatic air embolism after percutaneous transthoracic lung biopsy (PTLB) by conducting a systematic review and pooled analysis.
METHODS
We searched the EMBASE and OVID-MEDLINE databases to identify studies that dealt with air embolism after PTLB and had extractable outcomes. The incidence of air embolism was pooled using a random effects model, and the causes of heterogeneity were investigated. To analyze risk factors for symptomatic embolism and unfavorable outcomes, multivariate logistic regression analysis was performed.
RESULTS
The pooled incidence of symptomatic air embolism after PTLB was 0.08% (95% confidence interval [CI], 0.048-0.128%; I = 45%). In the subgroup analysis and meta-regression, guidance modality and study size were found to explain the heterogeneity. Of the patients with symptomatic air embolism, 32.7% had unfavorable outcomes. The presence of an underlying disease (odds ratio [OR], 5.939; 95% CI, 1.029-34.279; p = 0.046), the use of a ≥ 19-gauge needle (OR, 10.046; 95% CI, 1.103-91.469; p = 0.041), and coronary or intracranial air embolism (OR, 19.871; 95% CI, 2.725-14.925; p = 0.003) were independent risk factors for symptomatic embolism. Unfavorable outcomes were independently associated with the use of aspiration biopsy rather than core biopsy (OR, 3.302; 95% CI, 1.149-9.492; p = 0.027) and location of the air embolism in the coronary arteries or intracranial spaces (OR = 5.173; 95% CI = 1.309-20.447; p = 0.019).
CONCLUSION
The pooled incidence of symptomatic air embolism after PTLB was 0.08%, and one-third of cases had sequelae or died. Identifying whether coronary or intracranial emboli exist is crucial in suspected cases of air embolism after PTLB.
KEY POINTS
• The pooled incidence of symptomatic air embolism after percutaneous transthoracic lung biopsy was 0.08%, and one-third of patients with symptomatic air embolism had sequelae or died. • The risk factors for symptomatic air embolism were the presence of an underlying disease, the use of a ≥ 19-gauge needle, and coronary or intracranial air embolism. • Sequelae and death in patients with symptomatic air embolism were associated with the use of aspiration biopsy and coronary or intracranial locations of the air embolism.
Topics: Biopsy, Needle; Embolism, Air; Humans; Incidence; Lung; Prognosis; Risk Factors; Tomography, X-Ray Computed
PubMed: 33051730
DOI: 10.1007/s00330-020-07372-w -
British Journal of Anaesthesia Dec 2018A man with neuromuscular respiratory failure requiring intubation and ventilation suffered a venous air embolism during inadvertent administration of 5 ml of air....
A man with neuromuscular respiratory failure requiring intubation and ventilation suffered a venous air embolism during inadvertent administration of 5 ml of air. Ultrasound (US) imaging confirmed an air embolus in the left subclavian vein, which was only partially treated by US-guided aspiration. The embolus completely resolved on US imaging during hyperbaric oxygen therapy, and the patient recovered with no complications secondary to the embolism. Venous air embolism is under-recognised, and can cause siginificant neurological morbidity and death if untreated. When available, urgent hyperbaric oxygen therapy appears to be an effective approach.
Topics: Aged; Embolism, Air; Humans; Hyperbaric Oxygenation; Male; Subclavian Vein; Ultrasonography
PubMed: 30442247
DOI: 10.1016/j.bja.2018.09.003 -
The Medical Journal of Malaysia Jun 2019Cerebral air embolism is potentially a catastrophic event that occurs as a consequence of air entry into the vasculature. We report a mechanically ventilated 72-year-old...
Cerebral air embolism is potentially a catastrophic event that occurs as a consequence of air entry into the vasculature. We report a mechanically ventilated 72-year-old woman who underwent multiple procedures during intensive care stay with few possible sources of emboli postulated. We also discuss regarding the preventive measures to minimise the risk of air embolism.
Topics: Aged; Embolism, Air; Female; Humans; Intracranial Embolism; Tomography, X-Ray Computed
PubMed: 31256178
DOI: No ID Found -
Intensive Care Medicine May 2002To assess the relationship between the time period before hyperbaric oxygenation therapy (HBO) and clinical outcome in patients with iatrogenic cerebral air embolism.
OBJECTIVES
To assess the relationship between the time period before hyperbaric oxygenation therapy (HBO) and clinical outcome in patients with iatrogenic cerebral air embolism.
DESIGN AND SETTING
Retrospective study in a hyperbaric chamber and medical intensive care unit of a university hospital.
PATIENTS
All patients with air embolism from 1980 to 1999.
INTERVENTIONS
We retrieved the cases of 86 patients who benefited from an identical HBO and analyzed the relationship between the time period before HBO and clinical outcome.
RESULTS
Patients treated with HBO less than 6 h had a better outcome than those treated later. In patients treated within this delay the cause was venous air embolism in 84% and arterial air embolism in only 16% of cases. After this delay the cause was venous air embolism (53%) and arterial air embolism (47%). Patients with venous air embolism and recovery had a shorter delay than patients with sequelae or death (2 h 15 min vs. 4 h). Patients with venous air embolism treated less than 6 h had a better outcome than those treated later. In patients with arterial air embolism the time period before HBO was longer than in venous air embolism (8 h vs. 3 h) and the outcome worse (recovery in 35% vs. 67%). In patients with arterial air embolism no difference in the time period was found between patients with recovery and sequelae or death.
CONCLUSIONS
We stress the beneficial effect of an early HBO in air embolism, the importance of an increased awareness of physicians concerned with this severe complication, and the need to develop techniques to detect air emboli in the cerebral circulation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Embolism, Air; Female; Humans; Hyperbaric Oxygenation; Iatrogenic Disease; Male; Middle Aged; Retrospective Studies; Time Factors; Treatment Outcome
PubMed: 12029402
DOI: 10.1007/s00134-002-1255-0 -
Klinische Monatsblatter Fur... Mar 2010Life-threatening complications are extremely rare in ophthalmic surgery. If they occur, then mostly because of a pre-existing severe cardiovascular condition of the... (Review)
Review
Life-threatening complications are extremely rare in ophthalmic surgery. If they occur, then mostly because of a pre-existing severe cardiovascular condition of the patient, and only to a much lesser extent because of the operation of the eye itself. One theoretically possible complication is an air embolisation during air tamponade of the vitreous cavity with simultaneously opened choroidal vessels. There are some descriptions of such possible cases of air embolisation in the anaesthesiologic literature. Vitreoretinal surgeons should be aware of the theoretically possible complication of air embolisation during vitrectomy with air tamponade and simultaneously opened choroidal vessels.
Topics: Embolism, Air; Humans; Vitrectomy
PubMed: 20195955
DOI: 10.1055/s-0028-1109959 -
Plastic and Reconstructive Surgery Jul 1988The possibility of venous air embolism exists whenever the craniofacial operative field is above the level of the heart. Craniotomy with the high-torque craniotome is... (Review)
Review
The possibility of venous air embolism exists whenever the craniofacial operative field is above the level of the heart. Craniotomy with the high-torque craniotome is hypothesized to have produced venous air embolism in the patient described in this report. The diagnosis of venous air embolism is determined by transesophageal Doppler probe, transesophageal echocardiogram or external echocardiogram, and end-tidal N2 and CO2 determinations. Treatment includes control of the air entry sites, aspiration of air from the right atrium via a catheter placed prior to operation, and discontinuing nitrous oxide. If these measures are unsuccessful, the operative field should be transposed below heart level and the procedure terminated. In the event of significant hemodynamic compromise, closed cardiac massage should be tried; if that fails, open cardiac massage and direct aspiration are necessary. The true incidence of venous air embolism in craniofacial operations may be much higher than previously suspected. We therefore recommend placement of appropriate monitoring equipment to detect intracardiac air in those major craniofacial procedures in which there is a potential for intravascular air ingress.
Topics: Craniosynostoses; Embolism, Air; Female; Humans; Infant; Intraoperative Complications; Skull; Veins
PubMed: 3289061
DOI: No ID Found -
The Journal of Thoracic and... Nov 1980Massive air embolism during cardiopulmonary bypass is a frightening complication requiring immediate response and carrying strong medicolegal implications. From July,...
Massive air embolism during cardiopulmonary bypass is a frightening complication requiring immediate response and carrying strong medicolegal implications. From July, 1971, to July, 1979, there were eight instances of massive air embolism during 3,620 cardiopulmonary bypass operations. Five such accidents from other institutions are included in this report. Causes were (1) inattention to reservoir level, (2) reversal of pump head tubing or direction of pump head rotation, (3) unexpected resumption of heartbeat, (4) inadequate steps to remove air after cardiotomy, (5) high-flow suction deep in a pulmonary artery, (6) defective oxygenator, (7) use of a pressurized cardiotomy reservoir, and (8) inadvertent detachment of oxygenator during bypass. Prevention includes a systematic check of pump suckers and perfusion lines before bypass, a sensing device on the oxygenator reservoir, secure fixation of the oxygenator and avoidance of traffic around pump equipment, immediate cessation of pump and inspection for abnormal noise, use of standard maneuvers to remove air from the heart, and carotid compression with resumption of heartbeat. Immediate management of massive air embolism consists of placing the patient in a deep Trendelenburg position and making a large stab wound in the ascending aorta for retrograde drainage from the cerebrovascular bed. Temporary retrograde perfusion through the superior vena cava (SVC) may also be used. Subsequent steps are hypothermia with the resumption of cardiopulmonary bypass, elevation of blood pressure, steroids, ventilation with 100% oxygen, and deep barbiturate anesthesia. Among the 13 patients, there were four instantaneous deaths. Cerebral injury which resolved within a 2 month period occurred in three patients. The remainder had no neurologic sequelae. Nonfatal cerebral air injury may be associated with prolonged convalescence yet complete recovery, as compared to embolism from debris or clot, which offers a poorer prognosis.
Topics: Adult; Aged; Cardiopulmonary Bypass; Child, Preschool; Embolism, Air; Female; Humans; Intracranial Embolism and Thrombosis; Intraoperative Complications; Male; Middle Aged
PubMed: 7431967
DOI: No ID Found