Ibrahim Yussr M, Marques Nicole R, Garcia Carlos R, Salter Michael, McQuitty Christopher, Kinsky Michael, Juan Mindy, Ludomirsky Achiau
1Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX USA.
2Department of Anesthesiology, Kadlec Regional Medical Center, Pasco, WA USA.
Perioper Med (Lond). 2018 Nov 8;7:23. doi: 10.1186/s13741-018-0104-9. eCollection 2018.
Intravascular air embolism (AE) is a preventable but potentially catastrophic complication caused by intravenous tubing, trauma, and diagnostic and surgical procedures. The potentially fatal risks of arterial AE are well-known, and emerging evidence demonstrates impact of venous AEs on inflammatory response and coagulation factors. A novel FDA-approved in-line air detection and purging system was used to detect and remove air caused by administering a rapid fluid bolus during surgery.
A prospective, randomized, case series was conducted. Subjects were observed using standard monitors, including transesophageal echocardiography (TEE) in the operating room. After general anesthesia was induced, an introducer and pulmonary artery catheter was inserted in the right internal jugular to administer fluids and monitor cardiac pressures. Six patients undergoing cardiac surgery were studied. Each patient received four randomized fluid boluses: two with the in-line air purging device, two without. For each bolus, a bulb infuser was squeezed three times (10-15 mL) over 5 s. The TEE was positioned in the mid-esophageal right atrium (RA) to quantify peak air clearance, and images were video recorded throughout each bolus. Air was quantified using optical densitometry (OD) from images demonstrating maximal air in the RA.
All subjects demonstrated significantly lower air burden when the air reduction device was used ( = 0.004), and the average time to clear 90% of air was also lower, 3.7 ± 1.2 s vs. 5.3 ± 1.3 s ( < 0.001).
An air purging system reduced air burden from bolus administration and could consequently reduce the risk of harmful or fatal AEs during surgery.
血管内空气栓塞（AE）是一种由静脉输液管、外伤以及诊断和外科手术引起的可预防但可能具有灾难性的并发症。动脉性AE的潜在致命风险众所周知，并且新出现的证据表明静脉性AE对炎症反应和凝血因子有影响。一种新的经美国食品药品监督管理局（FDA）批准的在线空气检测和清除系统被用于检测和清除手术期间快速推注液体所产生的空气。
进行了一项前瞻性、随机、病例系列研究。在手术室使用包括经食管超声心动图（TEE）在内的标准监测仪对受试者进行观察。诱导全身麻醉后，在右颈内静脉插入一根导管鞘和肺动脉导管，用于输液和监测心脏压力。对6例接受心脏手术的患者进行了研究。每位患者接受四次随机推注液体：两次使用在线空气清除装置，两次不使用。对于每次推注，在5秒内将球囊输液器挤压三次（10 - 15毫升）。将TEE置于食管中段右心房（RA）以量化空气清除峰值，并在每次推注过程中全程录制图像。使用光学密度测定法（OD）从显示RA中最大空气量的图像对空气进行量化。
使用空气减少装置时，所有受试者的空气负荷均显著降低（P = 0.004），清除90%空气的平均时间也更短，分别为（3.7 ± 1.2）秒和（5.3 ± 1.）秒（P < 0.001）。
空气清除系统可减少推注液体产生的空气负荷，从而降低手术期间发生有害或致命性AE的风险。
