Zhu Gui-Wei, Li Yan-Min, Yue Wen-Hui, Sun Jian-Xia, Zhou Xin, Xu Ying-Xia, Wang Hai-Bo, Zhang Qing-Hai
Department of Critical Care Medicine, The First Affiliated Hospital of Shandong Second Medical University, Weifang 261000, Shandong Province, China.
Office of Medical Affairs, The First Affiliated Hospital of Shandong Second Medical University, Weifang 261042, Shandong Province, China.
World J Clin Cases. 2024 Jul 6;12(19):4016-4021. doi: 10.12998/wjcc.v12.i19.4016.
Venous air embolism (VAE) is a potentially lethal condition, with a reported incidence rate of about 0.13%, and the true incidence may be higher since many VAE are asymptomatic. The current treatments for VAE include Durant's maneuver, aspiration and removal of air through venous catheters, and hyperbaric oxygen therapy. For critically ill patients, use of cardiotonic drugs and chest compressions remain useful strategies. The wider availability of extracorporeal membrane oxygenation (ECMO) has brought a new option for VAE patients.
A 53-year-old female patient with VAE presented to the emergency clinic due to abdominal pain with fever for 1 d and unconsciousness for 2 h. One day ago, the patient suffered from abdominal pain, fever, and diarrhea. She suddenly became unconscious after going to the toilet during the intravenous infusion of ciprofloxacin 2 h ago, accompanied by nausea and vomiting, during which a small amount of gastric contents were discharged. She was immediately sent to a local hospital, where cranial and chest computed tomography showed bilateral pneumonia as well as accumulated air visible in the right ventricle and pulmonary artery. The condition deteriorated despite endotracheal intubation, rehydration, and other treatments, and the patient was then transferred to our hospital. Veno-arterial ECMO was applied in our hospital, and the patient's condition gradually improved. The patient was successfully weaned from ECMO and extubated after two days.
ECMO may be an important treatment for patients with VAE in critical condition.
静脉空气栓塞（VAE）是一种潜在的致命病症，报告的发病率约为0.13%，由于许多VAE无症状，实际发病率可能更高。目前VAE的治疗方法包括Durant手法、通过静脉导管抽吸和排出空气以及高压氧治疗。对于重症患者，使用强心药物和胸外按压仍然是有用的策略。体外膜肺氧合（ECMO）的更广泛应用为VAE患者带来了新的选择。
一名53岁的VAE女性患者因腹痛伴发热1天、昏迷2小时就诊于急诊诊所。一天前，患者出现腹痛、发热和腹泻。2小时前在静脉输注环丙沙星期间上厕所后突然昏迷，伴有恶心和呕吐，期间吐出少量胃内容物。她立即被送往当地医院，头颅和胸部计算机断层扫描显示双侧肺炎以及右心室和肺动脉可见积气。尽管进行了气管插管、补液和其他治疗，病情仍恶化，随后患者被转至我院。我院应用了静脉-动脉ECMO，患者病情逐渐好转。两天后患者成功脱离ECMO并拔管。
ECMO可能是重症VAE患者的重要治疗方法。
