A Microscopic View of Gaseous Microbubbles Passing a Filter Screen

Johagen, Daniel; Svenmarker, Pontus; Jönsson, Per; Svenmarker, Staffan

doi:10.5301/ijao.5000602

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“…Accidental injection or infusion of larger amounts of air may cause severe pulmonary emboli if entered intravenously or cerebral emboli if entering through the carotid arteries. During a cardiopulmonary bypass, gaseous microemboli (ME) have been recognized with different side effects [ 1 , 2 ], although air detectors have limited detection capacity [ 3 , 4 ]. Little is known about smaller volumes of accidental air contamination into the veins during injections and/or infusions of medication or nutrition in patients with severe stages of diseases such as amyotrophic lateral sclerosis (ALS).…”

Section: Introductionmentioning

confidence: 99%

Microemboli induced by air bubbles may be deposited in organs as a consequence of contamination during medical care

Forsberg

Jönsson

Stegmayr

2022

Clinical Kidney Journal

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Background Larger volumes of accidental air infused during medical care may end up as emboli while microbubbles of air are supposed to be absorbed and cause no harm. The aim of this autopsy study was to investigate if microbubbles of air accidently entering the bloodline may be detected as microemboli in tissue such as lungs, brain and heart. If so would differences in prevalence exist between HD and ALS patients. Methods Included were data from 44 patients treated by medical health care before death. Twenty-five cases had been treated with chronic hemodialysis (HD-group), 19 cases died from amyotrophic lateral sclerosis (ALS-group). Since air in the bloodline would activate coagulation microemboli could appear. To discriminate between microbubbles caused by artificial contamination during autopsy versus microbubbles deposited in vivo, tissues were stained with a polyclonal fluorescent antibody against fibrinogen, fibrin and fragments E and D. Fluorescence staining was used to visualize microemboli counted within 25 microscopic fields (600 x) of a tissue preparation. One tissue preparation was used if available from lung, heart and frontal lobe of the brain and in five cases also cerebellum. Results Microbubbles can be verified at autopsy as microemboli in lung, heart and brain in tissue from patients exposed to more extensive medical care. There were significantly more microemboli/tissue sections in the lungs versus the heart or brain. Women had fewer microemboli than men. The HD-group had a higher median of microemboli/section than the ALS-group: for the lung (6 vs 3, p = 0.007), heart (2.5 vs 1, p = 0.013) and brain (7.5 vs 2, p = 0.001), and had more sections with microemboli findings than the ALS-group (p = 0.002). A correlation existed between the time on HD (months) and microemboli in the lungs. Conclusions More microemboli findings were present in HD patients compared to those who suffered from ALS. Minimizing air contamination from syringes, infusion- and bloodlines will decrease microemboli and subsequent tissue injury.

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Section: Introductionmentioning

confidence: 99%