Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies
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,...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1230049/full |
| _version_ | 1797323484564553728 |
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| author | Phillip L. Marsh Ernest E. Moore Hunter B. Moore Connor M. Bunch Michael Aboukhaled Shaun M. Condon Shaun M. Condon Mahmoud D. Al-Fadhl Samuel J. Thomas John R. Larson Charles W. Bower Craig B. Miller Michelle L. Pearson Christopher L. Twilling David W. Reser George S. Kim George S. Kim Brittany M. Troyer Brittany M. Troyer Doyle Yeager Scott G. Thomas Daniel P. Srikureja Shivani S. Patel Shivani S. Patel Sofía L. Añón Anthony V. Thomas Joseph B. Miller David E. Van Ryn David E. Van Ryn David E. Van Ryn Saagar V. Pamulapati Devin Zimmerman Byars Wells Peter L. Martin Christopher W. Seder John G. Aversa Ryan B. Greene Robert J. March Hau C. Kwaan Daniel H. Fulkerson Daniel H. Fulkerson Stefani A. Vande Lune Tom E. Mollnes Tom E. Mollnes Tom E. Mollnes Erik W. Nielsen Erik W. Nielsen Erik W. Nielsen Erik W. Nielsen Benjamin S. Storm Benjamin S. Storm Benjamin S. Storm Mark M. Walsh Mark M. Walsh |
| author_facet | Phillip L. Marsh Ernest E. Moore Hunter B. Moore Connor M. Bunch Michael Aboukhaled Shaun M. Condon Shaun M. Condon Mahmoud D. Al-Fadhl Samuel J. Thomas John R. Larson Charles W. Bower Craig B. Miller Michelle L. Pearson Christopher L. Twilling David W. Reser George S. Kim George S. Kim Brittany M. Troyer Brittany M. Troyer Doyle Yeager Scott G. Thomas Daniel P. Srikureja Shivani S. Patel Shivani S. Patel Sofía L. Añón Anthony V. Thomas Joseph B. Miller David E. Van Ryn David E. Van Ryn David E. Van Ryn Saagar V. Pamulapati Devin Zimmerman Byars Wells Peter L. Martin Christopher W. Seder John G. Aversa Ryan B. Greene Robert J. March Hau C. Kwaan Daniel H. Fulkerson Daniel H. Fulkerson Stefani A. Vande Lune Tom E. Mollnes Tom E. Mollnes Tom E. Mollnes Erik W. Nielsen Erik W. Nielsen Erik W. Nielsen Erik W. Nielsen Benjamin S. Storm Benjamin S. Storm Benjamin S. Storm Mark M. Walsh Mark M. Walsh |
| author_sort | Phillip L. Marsh |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T05:29:21Z |
| format | Article |
| id | doaj.art-d09d7211f5134a17895210d4cf73d16b |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-08T05:29:21Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj.art-d09d7211f5134a17895210d4cf73d16b2024-02-06T08:50:16ZengFrontiers Media S.A.Frontiers in Immunology1664-32242023-09-011410.3389/fimmu.2023.12300491230049Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapiesPhillip L. Marsh0Ernest E. Moore1Hunter B. Moore2Connor M. Bunch3Michael Aboukhaled4Shaun M. Condon5Shaun M. Condon6Mahmoud D. Al-Fadhl7Samuel J. Thomas8John R. Larson9Charles W. Bower10Craig B. Miller11Michelle L. Pearson12Christopher L. Twilling13David W. Reser14George S. Kim15George S. Kim16Brittany M. Troyer17Brittany M. Troyer18Doyle Yeager19Scott G. Thomas20Daniel P. Srikureja21Shivani S. Patel22Shivani S. Patel23Sofía L. Añón24Anthony V. Thomas25Joseph B. Miller26David E. Van Ryn27David E. Van Ryn28David E. Van Ryn29Saagar V. Pamulapati30Devin Zimmerman31Byars Wells32Peter L. Martin33Christopher W. Seder34John G. Aversa35Ryan B. Greene36Robert J. March37Hau C. Kwaan38Daniel H. Fulkerson39Daniel H. Fulkerson40Stefani A. Vande Lune41Tom E. Mollnes42Tom E. Mollnes43Tom E. Mollnes44Erik W. Nielsen45Erik W. Nielsen46Erik W. Nielsen47Erik W. Nielsen48Benjamin S. Storm49Benjamin S. Storm50Benjamin S. Storm51Mark M. Walsh52Mark M. Walsh53Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, CO, United StatesUniversity of Colorado Health Transplant Surgery - Anschutz Medical Campus, Aurora, CO, United StatesDepartment of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United StatesIndiana University School of Medicine, South Bend, IN, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Goshen Health, Goshen, IN, United StatesDepartment of Emergency Medicine, Goshen Health, Goshen, IN, United StatesDepartment of Family Medicine, Saint Joseph Health System, Mishawaka, IN, United StatesDepartment of Family Medicine, Saint Joseph Health System, Mishawaka, IN, United StatesDepartment of Family Medicine, Saint Joseph Health System, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Goshen Health, Goshen, IN, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Goshen Health, Goshen, IN, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Goshen Health, Goshen, IN, United StatesDepartment of Emergency Medicine, Goshen Health, Goshen, IN, United StatesDepartment of Trauma & Surgical Research Services, South Bend, IN, United StatesDepartment of Trauma & Surgical Research Services, South Bend, IN, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesIndiana University School of Medicine, South Bend, IN, United StatesDepartment of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Goshen Health, Goshen, IN, United StatesDepartment of Emergency Medicine, Beacon Health System, Elkhart, IN, United States0Department of Internal Medicine, Mercy Health Internal Medicine Residency Program, Rockford, IL, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Goshen Health, Goshen, IN, United States1Department of Cardiovascular and Thoracic Surgery, RUSH Medical College, Chicago, IL, United States1Department of Cardiovascular and Thoracic Surgery, RUSH Medical College, Chicago, IL, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States2Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, IL, United StatesDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesDepartment of Trauma & Surgical Research Services, South Bend, IN, United States3Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, VA, United States4Research Laboratory, Nordland Hospital, Bodø, Norway5Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway6Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway5Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway7Department of Anesthesia and Intensive Care Medicine, Surgical Clinic, Nordland Hospital, Bodø, Norway8Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway9Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway7Department of Anesthesia and Intensive Care Medicine, Surgical Clinic, Nordland Hospital, Bodø, Norway8Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway9Faculty of Nursing and Health Sciences, Nord University, Bodø, NorwayDepartment of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United StatesIndiana University School of Medicine, South Bend, IN, United StatesIatrogenic 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.https://www.frontiersin.org/articles/10.3389/fimmu.2023.1230049/fullair embolismdecompression sicknesshyperbaric oxygenationthromboinflammationmicrobubblesarterioles |
| spellingShingle | Phillip L. Marsh Ernest E. Moore Hunter B. Moore Connor M. Bunch Michael Aboukhaled Shaun M. Condon Shaun M. Condon Mahmoud D. Al-Fadhl Samuel J. Thomas John R. Larson Charles W. Bower Craig B. Miller Michelle L. Pearson Christopher L. Twilling David W. Reser George S. Kim George S. Kim Brittany M. Troyer Brittany M. Troyer Doyle Yeager Scott G. Thomas Daniel P. Srikureja Shivani S. Patel Shivani S. Patel Sofía L. Añón Anthony V. Thomas Joseph B. Miller David E. Van Ryn David E. Van Ryn David E. Van Ryn Saagar V. Pamulapati Devin Zimmerman Byars Wells Peter L. Martin Christopher W. Seder John G. Aversa Ryan B. Greene Robert J. March Hau C. Kwaan Daniel H. Fulkerson Daniel H. Fulkerson Stefani A. Vande Lune Tom E. Mollnes Tom E. Mollnes Tom E. Mollnes Erik W. Nielsen Erik W. Nielsen Erik W. Nielsen Erik W. Nielsen Benjamin S. Storm Benjamin S. Storm Benjamin S. Storm Mark M. Walsh Mark M. Walsh Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies Frontiers in Immunology air embolism decompression sickness hyperbaric oxygenation thromboinflammation microbubbles arterioles |
| title | Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies |
| title_full | Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies |
| title_fullStr | Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies |
| title_full_unstemmed | Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies |
| title_short | Iatrogenic air embolism: pathoanatomy, thromboinflammation, endotheliopathy, and therapies |
| title_sort | iatrogenic air embolism pathoanatomy thromboinflammation endotheliopathy and therapies |
| topic | air embolism decompression sickness hyperbaric oxygenation thromboinflammation microbubbles arterioles |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2023.1230049/full |
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