Mechanisms underlying air aspiration in patients undergoing left atrial catheterization
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Mechanisms underlying air aspiration in patients undergoing left atrial catheterization. / Franzen, Olaf W; Klemm, Hanno; Hamann, Fiona; Koschyk, Dietmar; von Kodolitsch, Yskert; Weil, Jochen; Meinertz, Thomas; Baldus, Stephan.
in: CATHETER CARDIO INTE, Jahrgang 71, Nr. 4, 01.03.2008, S. 553-558.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Mechanisms underlying air aspiration in patients undergoing left atrial catheterization
AU - Franzen, Olaf W
AU - Klemm, Hanno
AU - Hamann, Fiona
AU - Koschyk, Dietmar
AU - von Kodolitsch, Yskert
AU - Weil, Jochen
AU - Meinertz, Thomas
AU - Baldus, Stephan
N1 - (c) 2008 Wiley-Liss, Inc.
PY - 2008/3/1
Y1 - 2008/3/1
N2 - BACKGROUND: Air embolism in patients undergoing percutaneous interventions requiring access to the left atrium (LA) represents a potentially fatal complication. Here we tested if a decline in LA pressures following sedation represents an important mechanistic link underlying air intrusion into the LA.METHODS AND RESULTS: Left atrial pressures were measured in 26 consecutive patients (49 +/- 14 years; 27% male), who underwent percutaneous atrial septal occlusion for persistent foramen ovale or secundum atrial septal defects. Patients either received sedation by propofol allowing for guidance by transesophageal echocardiography (n = 13) or underwent occluder implantation without sedation and under fluoroscopic control only (n = 13). Whereas mean expiratory LA pressures remained unchanged in either group, sedation provoked a marked decline in the mean inspiratory LA pressure as compared to non-sedated patients (Delta p 6.9 +/- 8.6 mm Hg vs. 0.1 +/- 1.2 mm Hg in nonsedated patients, P < 0.001). Ex vivo experiments evaluating the air-tightness of different sheaths in response to negative pressures revealed air aspiration at -13.4 +/- 1.2 mm Hg of suction in all cases, once a guide wire was inserted.CONCLUSIONS: Negative LA pressures in conjunction with air-leaking sheaths are identified as potentially important factors for air intrusion into the LA with the patient's sedation being a primary risk factor to lower LA pressure levels. The results advocate close monitoring of LA pressures during intervention, prevention of airway collapse and protection of LA sheaths from communication with the atmosphere, during procedures under sedation.
AB - BACKGROUND: Air embolism in patients undergoing percutaneous interventions requiring access to the left atrium (LA) represents a potentially fatal complication. Here we tested if a decline in LA pressures following sedation represents an important mechanistic link underlying air intrusion into the LA.METHODS AND RESULTS: Left atrial pressures were measured in 26 consecutive patients (49 +/- 14 years; 27% male), who underwent percutaneous atrial septal occlusion for persistent foramen ovale or secundum atrial septal defects. Patients either received sedation by propofol allowing for guidance by transesophageal echocardiography (n = 13) or underwent occluder implantation without sedation and under fluoroscopic control only (n = 13). Whereas mean expiratory LA pressures remained unchanged in either group, sedation provoked a marked decline in the mean inspiratory LA pressure as compared to non-sedated patients (Delta p 6.9 +/- 8.6 mm Hg vs. 0.1 +/- 1.2 mm Hg in nonsedated patients, P < 0.001). Ex vivo experiments evaluating the air-tightness of different sheaths in response to negative pressures revealed air aspiration at -13.4 +/- 1.2 mm Hg of suction in all cases, once a guide wire was inserted.CONCLUSIONS: Negative LA pressures in conjunction with air-leaking sheaths are identified as potentially important factors for air intrusion into the LA with the patient's sedation being a primary risk factor to lower LA pressure levels. The results advocate close monitoring of LA pressures during intervention, prevention of airway collapse and protection of LA sheaths from communication with the atmosphere, during procedures under sedation.
KW - Adult
KW - Atrial Function, Left/drug effects
KW - Cardiac Catheterization/adverse effects
KW - Cardiac Surgical Procedures/adverse effects
KW - Electrocardiography
KW - Embolism, Air/etiology
KW - Equipment Design
KW - Female
KW - Foramen Ovale, Patent/surgery
KW - Heart Atria/physiopathology
KW - Heart Septal Defects, Atrial/surgery
KW - Humans
KW - Hypnotics and Sedatives/adverse effects
KW - Inhalation/drug effects
KW - Male
KW - Middle Aged
KW - Pressure
KW - Propofol/adverse effects
KW - Risk Factors
U2 - 10.1002/ccd.21445
DO - 10.1002/ccd.21445
M3 - SCORING: Journal article
C2 - 18307231
VL - 71
SP - 553
EP - 558
JO - CATHETER CARDIO INTE
JF - CATHETER CARDIO INTE
SN - 1522-1946
IS - 4
ER -