The main objection against all forms of DIV is the fear of “the danger of "air embolism". Robins Method of Direct Intravenous Ozone Therapy℠ (a.k.a. RMDIV℠) uses only medical grade oxygen medical ozone generators with sealed systems, along with ozone resistant silicone tubing and glass tubes.

If you look up “Air Embolism” in the medical literature you may be surprised.

Most of the reports come from neurosurgery procedures where air often enters the venous system, and where 'clinical manifestations' of Vascular Air Embolism [VAE] appear in about 45% of the cases.

Anesthesiology references indicate those lethal doses of air in humans range from 200 to 500 cc of entrained vascular air, or 3 to 5 ml/kg.

That's a lot of air (well beyond RMDIV℠)at 4 ml/kg, which would mean 280 ml of air for a 154 lb person in a single dose. Not surprisingly, one report cites a fatal case of 100 ml of air per secondentering circulation during a subclavian venipuncture using a 14gauge (RMDIV℠ uses a 27gauge butterfly)needle. (Flanagan, Gradisar, Gross, and Kelly)

 

Also, it is not just the volume of air involved, but the speed of injection that also makes a difference (Toung, Roosberg, Hutchins). In fact, an anesthesiology textbook indicates that "The Lethal Dose" [LD] in humans can be exceeded if the air is entrained slowly, allowing for hemodynamic compensation. A bolus of air tends to lead to an increase in central venous pressure [CVP], a decrease in pulmonary artery pressure [PAP], and shock that is thought to be related to an air lock in the right ventricle. On thecontrary, a slow infusion of air results in an increase in CVP/PAP, with compensatory increase in cardiac output" (Mongan).

 

Non-lethal doses of VAE are reported as 2ml/kg or less (Bricker). In a 154 lb person, this would amount to 140 ml of AIR (not oxygen) entering the venous circulatory system. "The lungs appear to have a large capacity to compensate for air embolus within the pulmonary arterial circulation" (Emby and Ho). Other reports indicate "clinical manifestations" of VAE start appearing with dosages of 100 ml or more, particularly in neurosurgery procedures where air often enters the venous system. (Mongan). Anesthesiologists are trained to look out for these 'clinical manifestations', and to apply corrective measures. In fact, one of the measures taken is to have the patient breathe 100% oxygen. The points gathered from these cursory reference examples are fairly straightforward:

 

--A VAE lethal dose is a lot of air in the venous system; it is around 280 ml in a 154 lb person. --140 ml or less of air in the venous system is considered non-lethal in the literature. --Non-lethal VAE cases are fairly common in neurosurgery, are expected, and anesthesiologists are trained to deal with them.

(2) Given that the oxygen-depleted hemoglobin will absorb some of the gas, it would seem that staying below a single dose of 140 ml of oxygen/ozone would avoid even the "clinical manifestations" which the literature mentions, and which anesthesiologists must attend to in about 45% of neurosurgery cases. Almost all RMDIV℠ treatments never exceed 115cc, but range between 5 and 115cc.

The RMDIV℠ protocol falls well within safe parameters reported in the medical literature. Moreover, it is never AIR that is injected in the RMDIV℠procedure, but pure medical grade oxygen with a small percentage of ozone. Therefore there is no danger of “air embolism” feared by other ozone authorities and organizations. In the future it would be in the best interest of the medical ozone world if all discussions of various forms of intravenous ozone therapy were kept in the area of scientific knowledge and not unsupported feelings and opinions.

 

REFERENCES:

Flanagan JP, Gradisar IA,Gross RJ, Kelly TR: "Air Embolus--a lethal complication of subclavian venipuncture -New England J Med, 1969 Aug 28; Toung TJ, Rossberg, MI, Hutchins, GM: "Volume of Air in a Lethal Venous Air Embolism".- Anesthesiology, 2001 Feb; 94(2) Mongan P. "A Practical Approach To Neuroanesthesia". - Lippincott, 2013 Bricker S: "The Anaesthesia Science"- Cambridge University Press, second edition, 2009 Emby DJ, Ho K:"Air embolus revisited-a diagnostic and interventional radiological perspective" SA Journal of Radiology. March 2006 Han D, Lee KS, Franquet T, et. al.: "Thrombotic and nonthrombotic pulmonary arterial embolism: spectrum of imagining findings - Radiographics. November 2003, Vol 23 (6) O Donnell JM, Nacul, FE, Editors: "Surgical Intensive Care Medicine,second edition.. Springer, 2009 Muth CM, shank ES. Primary care: Gas embolism. New England J of Medicine. 2000;342:476–82 Fibel KH, Barness RP, Kinderknecht JJ: "Pressurized Intravenous Fluids Administration in the Professional Football Player. A Unique Setting for Venous Air Embolism".. Clin J Sport Med. 2015; 25(4):e67-9 Platz,E:"Tangential gunshot wound to the chest causing venous air embolism: a case report and review" - The Journal of Emergency Medicine.41 (2).2008 Dr. Howard Robins (O) 212-581-0101 (C) 516-967-1009