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Air embolism

INTRODUCTION

Air embolism is an uncommon but potentially catastrophic event that occurs as a consequence of the entry of air into the vasculature. A venous, or pulmonary air embolism occurs when air enters the systemic venous circulation and travels to the right ventricle and/or pulmonary circulation. An arterial air embolism results from introduction of air into the arterial system and can produce ischemia of any organ with poor collateral circulation [1-3].

The causes, pathophysiology, diagnosis, and treatment of air embolism will be discussed here. Issues related to the embolization of thrombi, amniotic fluid, fat, or tumor cells are discussed separately on designated topic reviews.

ETIOLOGY

Two conditions must be present for air embolism to occur:

  • A direct communication between a source of air and the vasculature must exist
  • A pressure gradient favoring the passage of air into the circulation (rather than bleeding from the vessel) must be present

Patients in the intensive care unit (ICU) are at particular risk for air embolism because they are subjected to a number of procedures in which these two conditions are commonly met (table 1). Examples include surgery, instrumentation of the central venous system, and positive pressure ventilation [1,2,4,5].
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