Bubbles in the body: The not so good, the bad, and the ugly

Goldman, Saul; Solano-Altamirano, J. Manuel; LeDez, Kenneth M.

doi:10.1016/b978-0-12-810519-1.00001-4

Cited by 2 publications

(5 citation statements)

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“…It has been previously described that air in the cerebral arterial circulation may cause an immediate increase in intracranial pressure (ICP) resulting in an "extremely inhomogeneous distribution" of cerebral blood flow (CBF) with localized heterogeneous ischemia and hyperemia (3). This is thought to be the cause of the recurrence of symptoms with resumption of ambient pressure after HBOT, which is welldescribed in the literature (50,58,59). Here, we review the anatomical and pathophysiologic foundations responsible for the varied clinical presentations, diagnoses, and treatments of iatrogenic air embolisms.…”

Section: Introductionmentioning

confidence: 90%

“…Animal studies have investigated how the pulmonary filtration system protects the systemic circulation, including cerebral and coronary circulations. These studies have defined the volume and rate of bubbles that can overwhelm this pulmonary filtration system and have provided insight into the thromboinflammatory changes at the level of the pulmonary endothelium, which produces the clinical response seen with varying volumes of air injected into the venous and arterial circulation ( 2 – 4 , 50 , 65 ).…”

Section: Pathoanatomy and Importance Of Patient Positioningmentioning

confidence: 99%

“…It is instructive to speak not just of bubble dimensions but also of vessel size. Arterioles range from 100–300 µm, and minimal thresholds for obstruction have been reported in experimental literature as ranging from 30–250 µm ( 2 , 29 , 50 ).…”

Section: Pathophysiology: the Immunothrombotic And Endothelial Respon...mentioning

confidence: 99%

“…Of significant interest is the well-known phenomenon of transient improvement at maximum atmospheric pressure followed by partial relapse of symptoms once the patient is returned to ambient pressure, which has been described in the DCI and iatrogenic air embolism literature ( 50 , 58 , 59 ).…”

Section: Therapymentioning

confidence: 99%

“…There have been advances in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies of bubbles in small vessels, including recent research regarding the thromboinflammatory changes at the level of the endothelium ( 12 , 29 – 50 ).…”

Section: Introductionmentioning

confidence: 99%

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Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies

Marsh,

Moore,

Moore

et al. 2023

Front. Immunol.

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Iatrogenic vascular air embolism is a relatively infrequent event but is associated with significant morbidity and mortality. These emboli can arise in many clinical settings such as neurosurgery, cardiac surgery, and liver transplantation, but more recently, endoscopy, hemodialysis, thoracentesis, tissue biopsy, angiography, and central and peripheral venous access and removal have overtaken surgery and trauma as significant causes of vascular air embolism. The true incidence may be greater since many of these air emboli are asymptomatic and frequently go undiagnosed or unreported. Due to the rarity of vascular air embolism and because of the many manifestations, diagnoses can be difficult and require immediate therapeutic intervention. An iatrogenic air embolism can result in both venous and arterial emboli whose anatomic locations dictate the clinical course. Most clinically significant iatrogenic air emboli are caused by arterial obstruction of small vessels because the pulmonary gas exchange filters the more frequent, smaller volume bubbles that gain access to the venous circulation. However, there is a subset of patients with venous air emboli caused by larger volumes of air who present with more protean manifestations. There have been significant gains in the understanding of the interactions of fluid dynamics, hemostasis, and inflammation caused by air emboli due to in vitro and in vivo studies on flow dynamics of bubbles in small vessels. Intensive research regarding the thromboinflammatory changes at the level of the endothelium has been described recently. The obstruction of vessels by air emboli causes immediate pathoanatomic and immunologic and thromboinflammatory responses at the level of the endothelium. In this review, we describe those immunologic and thromboinflammatory responses at the level of the endothelium as well as evaluate traditional and novel forms of therapy for this rare and often unrecognized clinical condition.

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Section: Introductionmentioning

confidence: 90%