However, even modest amounts of air can cause pulmonary vasoconstriction, right ventricular outflow tract obstruction, myocardial ischemia and even complete cardiovascular collapse” Bulsara et al (2019).
Extract:
The introduction of air into the arterial or venous circulatory system has been associated with devastating consequences. Yet, routine infusion of small amounts of air seems to be common. The concerning part, however, is that these small amounts of unmeasured air bubbles could add up over the course of an operation and patient hospitalization. Since iatrogenic causes account for the vast majority of vascular air embolisms (VAEs), often these events are preventable if careful measures are taken prior to or during specific interventions.1 As such, VAEs are now considered serious reportable events according to the National Quality Forum 2011 update and hospital acquired conditions by Center for Medicaid and Medicare.2-3 Despite the dire outcomes known to occur with VAE, currently, there remains a gap in our clinical knowledge in detecting and managing air micro-emboli and addressing the challenges in studying these occurrences.
Venous air embolism is the most common form of VAE and occurs as a complication of intravenous catheterization as well as numerous surgical procedures (Figure). Small amounts of venous air can be broken down and absorbed by the pulmonary vasculature without significant clinical effects. However, even modest amounts of air can cause pulmonary vasoconstriction, right ventricular outflow tract obstruction, myocardial ischemia and even complete cardiovascular collapse. What is even more concerning, is that up to 20% of people have a patent foramen ovale or atrial septal defect.1,4 This intracardiac shunting poses a risk of paradoxical embolism which could result in arterial emboli and cerebral infarcts. These oftentimes overlooked “harmless” air bubbles may be an under-recognized source of clinical deterioration.5
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Reference:
Bulsara, K.R., Lee, S. and Calafiore, R. (2019) Commentary: Air Bubbles in Infusion: An Easily Avoidable Potential Complication. Operative Neurosurgery. November 21st. doi: 10.1093/ons/opz351. [Epub ahead of print].