HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schlimp, C. J Articles by Lederer, W. Search for Related Content PubMed PubMed Citation Articles by Schlimp, C. J Articles by Lederer, W.

Cerebral Air Embolism, the Potential of Arterial and Venous Ascent

¹ Dept. of Anesthesiology and Critical Care Medicine, Trauma Hospital of Klagenfurt, Austria
² Dept. of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria

Dr. Christoph J Schlimp, Tel: +43-463-5890-1035, Fax: +43-463-5890-1038, Email: c.schlimp{at}gmx.at, Trauma Hospital of Klagenfurt, Waidmannsdorferstrasse 35, A-9021 Klagenfurt, Austria.

We read with great interest the case report by Seeburger et al. on massive cerebral air embolism with severe neurological impairment after surveillance bronchoscopy and central line removal.¹ The authors hypothesize that the mechanism of systemic venous air embolism reaching the cerebral vasculature in patients without intracardiac defects is most likely due to transpulmonary passage. In order to point to another differential diagnosis we would like to emphasize the potential of retrograde cerebral venous air embolism. Once air enters the central venous circulation, the lower specific weight of air bubbles as compared to blood will cause the bubbles to rise to cranial in a patient positioned upright, provided the air bubbles move at a velocity greater than that of the opposing blood flow in the vein. This depends on bubble size, vein diameter and cardiac output.² The mechanism of retrograde cerebral venous air embolism is even possible in the presence of valves in the jugular veins.³ As both, the right carotid artery as well as the right internal jugular vein emanate more centrally from the vascular system, cerebral injury after venous air embolism is more likely to be situated in the right hemisphere, even in patients not positioned on the left side.⁴

We agree with the authors that cerebral air embolism should be considered in patients with sudden neurologic deterioration after bronchoscopy or central venous line manipulations.

Physicians and nursing staff still need to increase awareness to this complication.^4,5

REFERENCES

1. Seeburger J, Borger MA, Merk DR, Doll S, Bittner HB, Mohr FW. Massive cerebral air embolism after bronchoscopy and central line manipulation. Asian Cardiovasc Thorac Ann 2009;17:67–9.[Abstract/Free Full Text]

2. Schlimp CJ, Loimer T, Rieger M, Lederer W, Schmidts MB. The potential of venous air embolism ascending retrograde to the brain. J Forensic Sci 2005;50:906–9.[Medline]

3. Nedelmann M, Pittermann P, Gast KK, Mueller-Forell W, Dieterich M. Involvement of jugular valve insufficiency in cerebral venous air embolism. J Neuroimaging 2007;17:258–60.[Medline]

4. Heckmann JG, Lang CJ, Kindler K, Huk W, Erbguth FJ, Neundorfer B. Neurologic manifestations of cerebral air embolism as a complication of central venous catheterization. Crit Care Med 2000;28:1621–5.[Medline]

5. Ely EW, Hite RD, Baker AM, Johnson MM, Bowton DL, Haponik EF. Venous air embolism from central venous catheterization: a need for increased physician awareness. Crit Care Med 1999;27:2113–7.[Medline]

Asian Cardiovasc Thorac Ann 2009; 17:541
© 2009 by SAGE Publications
DOI: 10.1177/0218492309344737

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schlimp, C. J Articles by Lederer, W. Search for Related Content PubMed PubMed Citation Articles by Schlimp, C. J Articles by Lederer, W.