1 Pulmonary, Critical Care and Sleep Medicine, Olive-View Medical Center, Sylmar, CA, USA.
2 David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
J Intensive Care Med. 2018 Sep;33(9):536-540. doi: 10.1177/0885066618766838. Epub 2018 Apr 3.
Cerebral artery gas embolism (CAGE) is a rare but serious adverse event with potentially devastating neurologic sequelae. Bronchoscopy is a frequently performed procedure but with only a few reported cases of CAGE.
We report the first documented case of CAGE associated with electromagnetic navigational bronchoscopy.
A 61-year-old man with a left lower lobe nodule underwent electromagnetic navigational bronchoscopy. The target lesion underwent transbronchial biopsy, brushing and an end-procedure lavage. Following the procedure, he developed seizures, evidence of hypoxic injury and cerebral edema, and air emboli were seen on computed tomography imaging. He then underwent treatment with hyperbaric oxygen with a full and complete neurologic recovery. Review of other cases reported in the literature suggests improved neurologic outcomes with hyperbaric oxygen treatment.
Biopsy techniques performed during bronchoscopy and electromagnetic navigational bronchoscopy can result in CAGE. Comparison with other reported cases suggests improved neurologic outcomes in those treated with hyperbaric oxygen. Prompt recognition of this complication and timely treatment with hyperbaric oxygen are the cornerstones to recovery.
脑动脉气体栓塞（CAGE）是一种罕见但严重的不良事件，可能导致严重的神经后遗症。支气管镜检查是一种经常进行的操作，但仅有少数几例 CAGE 的报告。
我们报告首例与电磁导航支气管镜检查相关的 CAGE 病例。
一名 61 岁男性因左下肺结节行电磁导航支气管镜检查。目标病变行经支气管镜活检、刷检和操作后灌洗。术后，他出现癫痫发作、缺氧性损伤和脑水肿的证据，计算机断层扫描成像显示空气栓塞。随后他接受高压氧治疗，完全恢复了神经功能。对文献中报告的其他病例进行回顾表明，高压氧治疗可改善神经结局。
支气管镜检查和电磁导航支气管镜检查过程中的活检技术可导致 CAGE。与其他报告的病例相比，高压氧治疗的患者神经结局改善。及时发现并及时用高压氧治疗是恢复的关键。
