We describe the first case of venous air embolism during percutaneous tracheostomy performed during continuous renal replacement therapy with citrate anticoagulation. Venous air embolism is a known risk during percutaneous dilatational tracheostomy; concurrent use of extracorporeal circuits may present a compounded risk due to the negative pressure developed by the blood pump. Use of regional citrate anticoagulation, permitting invasive procedures to be performed without discontinuing renal replacement therapy, may lead to an increase in the incidence of venous air embolism during tracheostomy.
Keywords: Tracheostomy; embolism; percutaneous tracheostomy; renal replacement therapy; venous air embolism.