luftemboli

Luftembolie, or air embolism, is the presence of air or other gas within the vascular system. It may be venous or arterial and can cause obstruction of blood flow and tissue hypoxia. Venous emboli typically reach the right heart and lungs, while arterial emboli can affect any organ, including the brain and heart, when gas enters arterial circulation via a shunt.

Common causes include medical procedures such as central venous catheter insertion or removal, surgical operations (notably in a sitting position), obstetric and gynecologic procedures, injection therapies, chest trauma, and decompression sickness in divers. Iatrogenic air entry is the most frequent cause in hospital settings.

Pathophysiology depends on volume and rate of air entry. Small amounts may be filtered by the lungs with minimal symptoms. Large volumes can obstruct pulmonary blood flow, cause acute right‑sided failure, hypoxemia, and shock. If air reaches the arterial circulation (via a heart defect or intrapulmonary shunt), it may cause cerebral, myocardial, or spinal ischemia.

Clinical presentation varies by location and severity. Venous embolism often presents with sudden dyspnea, chest pain, cough, tachycardia, and hypotension. Arterial embolism produces focal neurological deficits, confusion, or loss of consciousness. A “mill wheel” cardiac murmur can be heard, though it is not always present.

Diagnosis relies on clinical suspicion and imaging, such as CT or echocardiography with bubble study. Management starts with stopping the source of air and providing 100% oxygen and supportive care; hyperbaric oxygen therapy is indicated for arterial embolism or persistent symptoms. In mobile central lines, aspiration of air may be attempted.

Prevention focuses on meticulous technique during central line care, procedures in high‑risk positions, and rapid air removal from systems. Prognosis depends on the amount of air and prompt treatment, ranging from full recovery to severe outcomes.