Administering 100% oxygen via a non-rebreather mask is an effective alternative treatment for cerebral air embolism complicating bronchoscopy when hyperbaric oxygen therapy is unavailable.
100% FiO2 via a non-rebreather mask can be an effective alternative management for cerebral air embolism when hyperbaric oxygen therapy is not readily available.
Absolute Event Rate: 0% vs 0%
Introduction: Cerebral air embolism leading to acute ischemic stroke is a rare but documented complication of bronchoscopy. Although infrequently encountered, recognizing the clinical presentation and initiating prompt treatment is important to reduce disability and improve outcomes. Description: An elderly male was discharged home after a reportedly uncomplicated endobronchial ultrasound-guided navigational bronchoscopy with transbronchial fine-needle aspiration (TBFNA) and biopsy for diagnosis of nodular densities visualized on prior lung CT scan. En route home, he developed sudden onset headache, became unresponsive and presented to the ED with obtundation, a right-gaze preference, and left-sided weakness. Non-contrast head CT demonstrated air in the subarachnoid space predominantly in the right hemisphere involving the right occipital, parietal, and posterior temporal lobes. CT angiogram showed no large vessel occlusion. CT perfusion showed a matched perfusion defect in the right parieto-occipital region. He was admitted to the neurocritical care unit and placed on 100% FiO2 via non-rebreather (NRB) oxygen mask at 15L/min while awaiting transfer to a facility capable of providing hyperbaric oxygen therapy (HBOT). On day 2, a repeat CT head demonstrated interval resolution of cerebral pneumocephalus, an evolving large area of sulcal effacement and loss of gray-white differentiation involving the right hemisphere. HBOT was not pursued further. An MRI was obtained on day 3 and showed restricted diffusion in portions of the posterior right parietal and occipital lobes. The patient’s ICU course was otherwise notable for focal sub-clinical seizures that were managed with levetiracetam and lacosamide. He had gradual improvement in his neurologic exam and was transferred to the floor on day 8 with eventual discharge to a rehabilitation facility. Discussion: This case demonstrates an exceedingly rare complication of cerebral air embolism leading to stroke after bronchoscopy with TBFNA. Although HBOT is considered the standard of care in previously reported cases, this case shows that if HBOT is not readily available, administering 100% FiO2 via a NRB mask can be an effective management alternative.
Rahman et al. (Sun,) reported a other. Administering 100% oxygen via a non-rebreather mask is an effective alternative treatment for cerebral air embolism complicating bronchoscopy when hyperbaric oxygen therapy is unavailable.