Air embolism following penetrating lung injuries

Air embolism in chest trauma

“…3,4,[12][13][14][15] Clinically, arterial AE usually presents with signs reflecting involvement of the cerebral and coronary circulation, although signs in virtually all end organs have been described. 9 Haemoptysis is frequently reported as an important sign but, in one large series, was observed in only 16% of patients. 3 Neurological manifestations may include blindness, convulsions, loss of consciousness, hemiplegia, cranial nerve signs and confusion.…”

“…Ventricular fibrillation can be precipitated by 0.5 mL air in the left anterior descending artery and 0.05 mL air in a coronary artery can cause focal infarction. 5,9,13 Air in the retinal vessels on fundoscopy, palpable skin crepitus and unexpected ischaemia in the extremities have all been described. 9 There are many diagnostic clues to the presence of arterial AE, but their absence does not exclude the diagnosis.…”

“…The lethal dose of air decreases as the rate of air entry increases; the estimated fatal dose in adult humans is 300-500 mL at 100 mL/s. 5,9 Slower infusion of air causes bubbles to lodge in the pulmonary arterioles, with activation of local inflammatory and coagulation mediators. This results in elevated pulmonary arterial pressures, pulmonary oedema and reduced lung compliance.…”

“…8 The usual pulmonary venous pressure is 5-10 cmH 2 O and any airway pressure above this, in the presence of a breach in a pulmonary vein, can lead to arterial AE. 9,11 Higher airway pressures can increase the likelihood of embolization of air through traumatic bronchovenous fistulae. 12 The Valsalva manoeuvre, coughing and positive pressure ventilation can all lead to high airway pressures and thus precipitate arterial AE.…”

“…3 Neurological manifestations may include blindness, convulsions, loss of consciousness, hemiplegia, cranial nerve signs and confusion. 9,13 Coronary artery AE results in sudden cardiovascular collapse due to myocardial ischaemia. Ventricular fibrillation can be precipitated by 0.5 mL air in the left anterior descending artery and 0.05 mL air in a coronary artery can cause focal infarction.…”