title: Fatal cerebral air embolism following uneventful flexible bronchoscopy.
abstract: Flexible bronchoscopy is a widely used and safe procedure with a reported maximal mortality rate of 0.04% and a major-complications rate of 0.5%. There are, however, only few case descriptions for postinterventional cerebral air embolism and the frequency of this supposedly rare complication is unknown. The current study presents 2 patients with non-small cell lung cancer who suffered fatal cerebral air embolism following diagnostic bronchoscopy with transbronchial needle aspiration and transbronchial biopsy, resulting in a frequency of <0.02% for this severe complication in our institution. In addition to early supportive measures, 1 patient received hyperbaric oxygen therapy as further treatment. Prompt recognition of this complication is mandatory in order to implement appropriate supportive measures. High-flow oxygen should be administered and hyperbaric oxygen therapy may be considered, if available. If possible, positive pressure ventilation should be avoided.
authors.affiliation: Clinic of Pulmonary Medicine, University Hospital Basel, Basel, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Azzola
authors.forename: Christophe
authors.initials: C
authors.lastname: von Garnier
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Chhajed
authors.forename: Udo
authors.initials: U
authors.lastname: Schirp
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000009:adverse effects*; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D011859:Radiography