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(Chest. 2005;128:2918-2932.)
© 2005 American College of Chest Physicians

Microbubbles*

Pathophysiology and Clinical Implications

Michal Barak, MD and Yeshayahu Katz, MD, DSc

* From the Department of Anesthesiology (Dr. Barak), Rambam Medical Center, Haifa; and Bruce Rappaport Faculty of Medicine (Dr. Katz), Technion-Israel Institute of Technology, Haifa, Israel.

Correspondence to: Yeshayahu Katz, MD, DSc, Department of Anesthesiology, HaEmek Medical Center, Afula 18101, Israel; e-mail: ykatz18{at}hotmail.com

Gas embolism is a known complication of various invasive procedures, and its management is well established. The consequence of gas microemboli, microbubbles, is underrecognized and usually overlooked in daily practice. We present the current data regarding the pathophysiology of microemboli and their clinical consequences. Microbubbles originate mainly in extracorporeal lines and devices, such as cardiopulmonary bypass and dialysis machines, but may be endogenous in cases of decompression sickness or mechanical heart valves. Circulating in the blood stream, microbubbles lodge in the capillary bed of various organs, mainly the lungs. The microbubble obstructs blood flow in the capillary, thus causing tissue ischemia, followed by inflammatory response and complement activation. Aggregation of platelets and clot formation occurs as well, leading to further obstruction of microcirculation and tissue damage. In this review, we present evidence of the biological and clinical detrimental effects of microbubbles as demonstrated by studies in animal models and humans, and discuss management of the microbubble problem with regard to detection, prevention, and treatment.

Key Words: dialysis • lung • pulmonary hypertension • surgery






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