Venous air embolism: Clinical and experimental considerations

To examine the existing literature concerning venous air embolism. Causes, patho-physiology, and management are emphasized. The literature that was reviewed was retrieved from the MEDLINE System under the headings "venous air embolism," "air embolism," "therapy of air embolism," "etiology of venous air embolism," and "pathophysiology of venous air embolism" for the years 1970 to 1991. A manual search, derived from the references of these papers, was performed to obtain relevant citations for the years preceding 1970. Experimental (animal) data, case reports, case series, and clinical investigations are included. Venous air embolism is an infrequent complication of invasive diagnostic and therapeutic maneuvers. The cardiovascular, pulmonary, and central nervous systems may all be affected, with severity ranging from no symptoms to immediate cardiovascular collapse. Therapeutic interventions include mechanical measures, such as positioning, withdrawal of air from the right atrium, and measures aimed at reducing bubble size. Hyperbaric oxygen therapy holds some promise in accomplishing the latter, but randomized, controlled trials demonstrating efficacy have yet to be performed. (Crit Care Med 1992; 20:1169–1177)