In Response

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We appreciate the comment made by Drs. Liang and Rice regarding our “Intravenous Air: The Partially Invisible Phenomenon” study. We agree that introducing air into the venous circulation may not cause harm and probably usually does not. Our concern is that it might, and when it happens in a vulnerable patient, it may result in a neurologic deficit or other significant morbidity. Because we cannot reliably predict in which patient a paradoxical gas embolus might occur (20%–30% of us have at least a probe patent foramen ovale), it behooves us to be aware of and minimize the opportunity for such an event as may occur in any patient with a right-to-left cardiac level shunt. The prevention of air embolism is a consistently recurring patient safety topic and we believe that drawing attention to the related little details, for example, outgassing of dissolved air in intravenous fluids, helps to remind us to keep track of the big sources of intravascular air embolism as well.
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