What is included in supportive care for venous air embolism (VAE)?

Updated: Dec 30, 2017
  • Author: Brenda L Natal, MD, MPH; Chief Editor: Erik D Schraga, MD  more...
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Answer

Supportive therapy should include fluid resuscitation (to increase intravascular volume, increase venous pressure and venous return). There is also some evidence that gas emboli may cause a relative hemoconcentration, which increases viscosity and impairs the already compromised circulation. Hypovolemia is less tolerated than relative anemia. In animal studies, moderate hemodilution to a hematocrit of 30% reduces neurologic damage. Crystalloids may cause cerebral edema; therefore, colloids are preferred for hemodilution. [1, 4, 18]

The administration of vasopressors and mechanical ventilation are two other supportive measures that may be necessary. [1, 4, 41] In a case report of a patient undergoing a craniotomy who showed cardiopulmonary findings suggestive of acute VAE, inotropic treatment with ephedrine seemed to rapidly reverse the cardiopulmonary abnormalities. Early inotropic support of the right ventricle has been recommended if venous air embolism is suspected. [41]

In animal studies, the use of perfluorocarbons (FP-43) has been shown to enhance the reabsorption of bubbles and the solubility of gases, thereby decreasing both neurologic and cardiovascular complications of systemic and coronary VAE. These benefits, however, have not been validated in humans. [1]


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