Swenson Kai E, Shaller Brian D, Duong Kevin, Bedi Harmeet
Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Thorac Dis. 2021 Nov;13(11):6439-6452. doi: 10.21037/jtd-21-717.
Systemic arterial gas embolism (SAGE) is a rare yet serious and underrecognized complication of bronchoscopic procedures. A recent case of presumed SAGE after transbronchial needle aspiration prompted a systematic literature review of SAGE after biopsy procedures during flexible bronchoscopy.
We performed a systematic database search for case reports and case series pertaining to SAGE after bronchoscopic lung biopsy; reports or series involving only bronchoscopic laser therapy or argon plasma coagulation (APC) were excluded. Patient data were extracted directly from published reports.
A total of 29 unique patient reports were assessed for patient demographics, specifics of the procedure, clinical manifestations, diagnostic findings, and clinical outcomes. Cases of SAGE occurred after multiple types of bronchoscopic biopsy and under both positive and negative pressure ventilation. The most common clinical findings were neurologic, followed by cardiac manifestations; temporal patterns included acute onset of cardiac or neurologic emergencies immediately after biopsy, or delayed awakening post-procedure. There was a high mortality rate among cases (28%), with residual neurologic deficits also common (24%).
SAGE is an underrecognized but severe adverse effect of bronchoscopic lung biopsy, which often presents with acute coronary or cerebral ischemia or delayed awakening from sedation. It is important for all physicians who perform bronchoscopic biopsies to be aware of the clinical manifestations and therapeutic management of SAGE in order to mitigate morbidity and mortality among patients undergoing these procedures.
系统性动脉气体栓塞（SAGE）是支气管镜检查中一种罕见但严重且未得到充分认识的并发症。最近一例经支气管针吸活检后疑似SAGE的病例促使我们对柔性支气管镜活检过程中SAGE的相关文献进行系统回顾。
我们对支气管镜肺活检后与SAGE相关的病例报告和病例系列进行了系统的数据库检索；仅涉及支气管镜激光治疗或氩等离子体凝固（APC）的报告或系列被排除。患者数据直接从已发表的报告中提取。
共评估了29份独特的患者报告，内容涉及患者人口统计学、手术细节、临床表现、诊断结果和临床结局。SAGE病例发生在多种类型的支气管镜活检后，且在正压和负压通气情况下均有发生。最常见的临床表现为神经系统症状，其次是心脏表现；时间模式包括活检后立即出现心脏或神经系统急症的急性发作，或术后延迟苏醒。病例的死亡率较高（28%），残留神经功能缺损也很常见（24%）。
SAGE是支气管镜肺活检一种未得到充分认识但严重的不良反应，常表现为急性冠状动脉或脑缺血或镇静后延迟苏醒。所有进行支气管镜活检的医生都应了解SAGE的临床表现和治疗管理，以降低接受这些手术患者的发病率和死亡率。
