Aggressive repeat manual pulmonary recruitment maneuver with pure oxygen as a new treatment of venous air embolism

Venous air embolism (VAE) is a largely iatrogenic clinical problem, which can result in serious morbidity and even death. Even with appropriate treatment, VAE still leads to a high overall one-year mortality. New feasible and effective treatment will be life-saving, especially when the routine treatment failed or is contraindicated. The manual pulmonary recruitment maneuver is an effective ventilation strategy to improve respiratory mechanics, increase pulmonary oxygen exchange and arterial oxygenation, and improve patient outcomes. Meanwhile, it could squeeze the heart, which could smash the air embolism and drive the air to move out from the pulmonary outflow tract then relieve the pulmonary obstruction. Recently, we success treatment a patient with intraoperative VAE by this maneuver as the routine treatment failed. However, there is still a lack of trials to evaluate the efficiency of a new treatment for VAE. Hence, we hypothesize that an aggressive repeat manual pulmonary recruitment maneuver with pure oxygen could be an effective alternative treatment in a patient with intraoperative VAE when the routine treatment failed or was contraindicated.