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Venous Air Embolism

Venous Air Embolism Abstract • Venous air embolism causes injury primarily by obstruction of blood flow from the right side of the heart to the left. This is due to mechanical obstruction of the right ventricular pulmonary outflow tract and pulmonary vasculature and to poorly understood pulmonary vasoconstrictive mechanisms. Venous air embolism can result in considerable hypoxemia from ventilation-perfusion maldistribution and shunt. With large emboli, systemic hypotension, myocardial ischemia, and arrhythmias can occur and result in death. One should be familiar with the clinical setting where embolism occurs, as prevention is the best treatment. When air embolism is suspected, placement of the patient in the left lateral decubitus position, initiating closed chest massage or, if possible, aspiration of air through a right atrial or Swan-Ganz catheter are all acceptable forms of treatment. The patient should also be given 100% oxygen. (Arch Intern Med 1982;142:2173-2176) References 1. Durant TM, Long J, Oppenheimer J: Pulmonary (venous) air embolism. Am Heart J 1947;33:269-281.Crossref 2. Hartveit F, Lystad H, Minken A: Pathology of venous air embolism. Br J Exp Pathol 1968;49:81-86. 3. Warren B, Philp B, Inwood M: The ultrastructural morphology of air embolism: Platelet adhesion to the interface and endothelial damage. Br J Exp Pathol 1973;54:163-172. 4. Khan M, Alkalay I, Suetsugu S, et al: Acute changes in lung mechanics following pulmonary emboli of various gases in dogs. J Appl Physiol 1972;33:774-777. 5. Kazuhiro 0, Kazuya N, Binder A, et al: Venous air emboli in sheep: Reversible increase in lung microvascular permeability. J Appl Physiol 1981;51:887-894. 6. Berglund E, Josephson S, Ovenfors CO: Pulmonary air embolism: Physiological aspects. Progr Respir Res 1970;5:259-263. 7. Albert R, Lakshminarayan S, Kirk W, et al: Lung inflation can cause pulmonary edema in zone I of in situ dog lungs. J Appl Physiol 1980;49: 815-819. 8. English J: Comparison of venous air embolism monitoring methods in supine dogs. Anesthesiology 1978;48:425-429.Crossref 9. Butler B, Hills B: The lung as a filter for microbubbles. J Appl Physiol 1979;47:537-543. 10. Spencer R: The significance of air embolism during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1965;49:615-634. 11. Hlastala M, Robertson T, Ross B: Gas exchange abnormalities produced by venous gas emboli. Respir Physiol 1979;36:1-17.Crossref 12. Hybels C: Venous air embolism in head and neck surgery. Laryngoscope 1980;90:946-954. 13. Tateishi T: Prospective study of air embolism. Br J Anaesth 1972;44: 1306-1310.Crossref 14. Edelman J, Wingard D: Air embolism arising from burr holes. Anesthesiology 1980;53:167-168.Crossref 15. Feliciano D, Mattox K, Grahan J, et al: Major complications of percutaneous subclavian vein catheters. Am J Surg 1979;138:869-874.Crossref 16. Flanagan J, Gradishar I, Gross R, et al: Air embolism: A lethal complication of subclavian venipuncture. N Engl J Med 1969;281:488-489.Crossref 17. Lucas CE, Irani F: Air embolism via subclavian catheter. N Engl J Med 1969;281:966-967. 18. Paskin D, Hoffman W, Tuddenham W: A new complication of subclavian vein catheterization. Ann Surg 1974;179:266-268.Crossref 19. Peters J, Armstrong R: Air embolism occurring as a complication of central venous catheterization. Ann Surg 1978;187:375-379.Crossref 20. Canahan T III: Air embolization during percutaneous Swan-Ganz catheter placement. Anesthesiology 1979;50:360-361.Crossref 21. Lucas C, Farrohli I: Air embolism via subclavian catheter. N Engl J Med 1969;281:966-967. 22. Johnson H: Delayed air embolism. Forensic Sci 1973;20:375-377.Crossref 23. Bowen F, Chandra R, Avery G: Pulmonary interstitial emphysema with gas embolism in hyaline membrane disease. Am J Dis Child 1973;126: 117-118. 24. Banagle R: Massive intracranial air embolism: A complication of mechanical ventilation. Am J Dis Child 1980;134:799-800. 25. Pomm R: Systemic air embolism in experimental penetrating lung injuries. J Thorac and Cardiovasc Surg 1977;74:766-773. 26. Thomas A, Stephens B: Air embolism: A cause of morbidity and death after penetrating chest trauma. J Trauma 1974;14:633-638.Crossref 27. Cleveland J: Fatal embolism to the right side of the heart during pneumonectomy for carcinoma: Result of broncho-azygous vein communication and positive pressure ventilation. Chest 1977;71:556-557.Crossref 28. Root B, Levy M, Pollack S, et al: Gas embolism death after laparoscopy delayed by trapping in portal circulation. Anesth Analg 1978;57: 232-237.Crossref 29. Yeakel A: Lethal air embolism from plastic blood-storage container. JAMA 1968;204:267-268.Crossref 30. Gottlieb J, Ericsson J, Sweet R: Venous air embolism: A review. Anesth Analg 1965;44:773-779.Crossref 31. Brechner V, Bethune R: Recent advances in monitoring pulmonary air embolism. Anesth Analg 1971;50:255-261. 32. Munson E, Paul W, Perry J, et al: Early detection of venous air embolism using a Swan-Ganz catheter. Anesthesiology 1975;42:223-228.Crossref 33. Peterson B, Graner S, Hyde R, et al: Response of pulmonary veins to increased intracranial pressure and pulmonary air embolism. J Appl Physiol 1980;48:957-964. 34. Chandler W, Dimcheff D, Taren J: Acute pulmonary edema following venous air embolism during a neurosurgical procedure: Case report. J Neurosurg 1974;40:400-404.Crossref 35. Ishah B, Seleny F, Noah Z: Venous air embolism: A possible cause of acute pulmonary edema. Anaesthesiol 1976;45:453-455.Crossref 36. Perschau R, Munson E, Chapin J: Pulmonary interstitial edema after multiple venous air emboli. Anaesthesiol 1976;45:364-368.Crossref 37. Marshall W, Bedford R: Use of a pulmonary artery catheter for detection and treatment of venous air embolism. Anesthesiology 1980;52: 131-134.Crossref 38. Hurter D, Sevel P: Detection of venous air embolism: A clinical report using end-tidal carbon dioxide monitoring during neurosurgery. Anaesthesia 1979;34:578-582.Crossref 39. Ericsson J, Gottlieb J, Sweet R: Closed-chest cardiac massage in the treatment of venous air embolism. N Engl J Med 1964;270:1353-1354.Crossref 40. Alvaran S, Toung J, Graff T, et al: Venous air embolism: Comparative merits of external cardiac massage, intracardiac aspiration, and left lateral decubitus position. Anesth Analg 1978;57:166-170.Crossref 41. Sink J: Evaluation of catheter placement in the treatment of venous air embolism. Ann Surg 1976;183:58-61.Crossref 42. Munson E: Effect of nitrous oxide on the pulmonary circulation during venous air embolism. Anesth Analg 1971;50:785-793.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340250139020
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Abstract

Abstract • Venous air embolism causes injury primarily by obstruction of blood flow from the right side of the heart to the left. This is due to mechanical obstruction of the right ventricular pulmonary outflow tract and pulmonary vasculature and to poorly understood pulmonary vasoconstrictive mechanisms. Venous air embolism can result in considerable hypoxemia from ventilation-perfusion maldistribution and shunt. With large emboli, systemic hypotension, myocardial ischemia, and arrhythmias can occur and result in death. One should be familiar with the clinical setting where embolism occurs, as prevention is the best treatment. When air embolism is suspected, placement of the patient in the left lateral decubitus position, initiating closed chest massage or, if possible, aspiration of air through a right atrial or Swan-Ganz catheter are all acceptable forms of treatment. The patient should also be given 100% oxygen. (Arch Intern Med 1982;142:2173-2176) References 1. Durant TM, Long J, Oppenheimer J: Pulmonary (venous) air embolism. Am Heart J 1947;33:269-281.Crossref 2. Hartveit F, Lystad H, Minken A: Pathology of venous air embolism. Br J Exp Pathol 1968;49:81-86. 3. Warren B, Philp B, Inwood M: The ultrastructural morphology of air embolism: Platelet adhesion to the interface and endothelial damage. Br J Exp Pathol 1973;54:163-172. 4. Khan M, Alkalay I, Suetsugu S, et al: Acute changes in lung mechanics following pulmonary emboli of various gases in dogs. J Appl Physiol 1972;33:774-777. 5. Kazuhiro 0, Kazuya N, Binder A, et al: Venous air emboli in sheep: Reversible increase in lung microvascular permeability. J Appl Physiol 1981;51:887-894. 6. Berglund E, Josephson S, Ovenfors CO: Pulmonary air embolism: Physiological aspects. Progr Respir Res 1970;5:259-263. 7. Albert R, Lakshminarayan S, Kirk W, et al: Lung inflation can cause pulmonary edema in zone I of in situ dog lungs. J Appl Physiol 1980;49: 815-819. 8. English J: Comparison of venous air embolism monitoring methods in supine dogs. Anesthesiology 1978;48:425-429.Crossref 9. Butler B, Hills B: The lung as a filter for microbubbles. J Appl Physiol 1979;47:537-543. 10. Spencer R: The significance of air embolism during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1965;49:615-634. 11. Hlastala M, Robertson T, Ross B: Gas exchange abnormalities produced by venous gas emboli. Respir Physiol 1979;36:1-17.Crossref 12. Hybels C: Venous air embolism in head and neck surgery. Laryngoscope 1980;90:946-954. 13. Tateishi T: Prospective study of air embolism. Br J Anaesth 1972;44: 1306-1310.Crossref 14. Edelman J, Wingard D: Air embolism arising from burr holes. Anesthesiology 1980;53:167-168.Crossref 15. Feliciano D, Mattox K, Grahan J, et al: Major complications of percutaneous subclavian vein catheters. Am J Surg 1979;138:869-874.Crossref 16. Flanagan J, Gradishar I, Gross R, et al: Air embolism: A lethal complication of subclavian venipuncture. N Engl J Med 1969;281:488-489.Crossref 17. Lucas CE, Irani F: Air embolism via subclavian catheter. N Engl J Med 1969;281:966-967. 18. Paskin D, Hoffman W, Tuddenham W: A new complication of subclavian vein catheterization. Ann Surg 1974;179:266-268.Crossref 19. Peters J, Armstrong R: Air embolism occurring as a complication of central venous catheterization. Ann Surg 1978;187:375-379.Crossref 20. Canahan T III: Air embolization during percutaneous Swan-Ganz catheter placement. Anesthesiology 1979;50:360-361.Crossref 21. Lucas C, Farrohli I: Air embolism via subclavian catheter. N Engl J Med 1969;281:966-967. 22. Johnson H: Delayed air embolism. Forensic Sci 1973;20:375-377.Crossref 23. Bowen F, Chandra R, Avery G: Pulmonary interstitial emphysema with gas embolism in hyaline membrane disease. Am J Dis Child 1973;126: 117-118. 24. Banagle R: Massive intracranial air embolism: A complication of mechanical ventilation. Am J Dis Child 1980;134:799-800. 25. Pomm R: Systemic air embolism in experimental penetrating lung injuries. J Thorac and Cardiovasc Surg 1977;74:766-773. 26. Thomas A, Stephens B: Air embolism: A cause of morbidity and death after penetrating chest trauma. J Trauma 1974;14:633-638.Crossref 27. Cleveland J: Fatal embolism to the right side of the heart during pneumonectomy for carcinoma: Result of broncho-azygous vein communication and positive pressure ventilation. Chest 1977;71:556-557.Crossref 28. Root B, Levy M, Pollack S, et al: Gas embolism death after laparoscopy delayed by trapping in portal circulation. Anesth Analg 1978;57: 232-237.Crossref 29. Yeakel A: Lethal air embolism from plastic blood-storage container. JAMA 1968;204:267-268.Crossref 30. Gottlieb J, Ericsson J, Sweet R: Venous air embolism: A review. Anesth Analg 1965;44:773-779.Crossref 31. Brechner V, Bethune R: Recent advances in monitoring pulmonary air embolism. Anesth Analg 1971;50:255-261. 32. Munson E, Paul W, Perry J, et al: Early detection of venous air embolism using a Swan-Ganz catheter. Anesthesiology 1975;42:223-228.Crossref 33. Peterson B, Graner S, Hyde R, et al: Response of pulmonary veins to increased intracranial pressure and pulmonary air embolism. J Appl Physiol 1980;48:957-964. 34. Chandler W, Dimcheff D, Taren J: Acute pulmonary edema following venous air embolism during a neurosurgical procedure: Case report. J Neurosurg 1974;40:400-404.Crossref 35. Ishah B, Seleny F, Noah Z: Venous air embolism: A possible cause of acute pulmonary edema. Anaesthesiol 1976;45:453-455.Crossref 36. Perschau R, Munson E, Chapin J: Pulmonary interstitial edema after multiple venous air emboli. Anaesthesiol 1976;45:364-368.Crossref 37. Marshall W, Bedford R: Use of a pulmonary artery catheter for detection and treatment of venous air embolism. Anesthesiology 1980;52: 131-134.Crossref 38. Hurter D, Sevel P: Detection of venous air embolism: A clinical report using end-tidal carbon dioxide monitoring during neurosurgery. Anaesthesia 1979;34:578-582.Crossref 39. Ericsson J, Gottlieb J, Sweet R: Closed-chest cardiac massage in the treatment of venous air embolism. N Engl J Med 1964;270:1353-1354.Crossref 40. Alvaran S, Toung J, Graff T, et al: Venous air embolism: Comparative merits of external cardiac massage, intracardiac aspiration, and left lateral decubitus position. Anesth Analg 1978;57:166-170.Crossref 41. Sink J: Evaluation of catheter placement in the treatment of venous air embolism. Ann Surg 1976;183:58-61.Crossref 42. Munson E: Effect of nitrous oxide on the pulmonary circulation during venous air embolism. Anesth Analg 1971;50:785-793.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1982

References