European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025
Risk of Air Embolism and On-site Management during Intraoperative Lung Nodule Localization in Hybrid Room: 7 Cases from a Single Institute.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Liu Xianping, Xing Huajie, Wang Zhiqiang
Аннотация
OBJECTIVES: To evaluate the incidence of air embolism and explore the underlying mechanisms and treatment strategies during intraoperative lung nodule localization under general anaesthesia in hybrid room.
METHODS: From June 2021 to October 2024, patients with suspicious lung nodule scheduled to elective surgery requiring intraoperative nodule localization in hybrid room were retrospectively studied. Lung nodule localization was performed under anaesthesia and intubation with computed tomography (CT) guidance, followed by repeat whole thorax scan to detect any complications. CT images were retrospectively evaluated by 2 radiologists and air embolism was defined as filling defect in main vessels or the heart.
RESULTS: A total of 1582 cases were reviewed, and 7 cases of air embolism (median age, 54 years; range, 36-68 years; 4 men) were detected, with an incidence of 0.44%. The median distance from the pleura to the target lesion was 25 mm (range, 10-60 mm). The median target lesion size was 8 mm (range, 6-15 mm). Identifiable vein branch adjacent to target nodule could be found in 6 (85.7%) patients. In 5 cases, air embolism was detected immediately after the procedure, while retrospectively revealed in 2 cases after surgery. Four (57.1%) patients developed related symptoms, including intraoperative cardiac arrest, blood pressure decline, postoperative hemiplegia, and visually impair. Cardiopulmonary resuscitation with chest compression was required in 2 patients. Adjustment to the Trendelenburg position was performed in 4 patients.
CONCLUSIONS: The increased risk of air embolism should be emphasized during intraoperative lung nodule localization in hybrid room, which might be related to the abnormal bronchial-vein fistula caused by the puncture and positive pressure ventilation. Avoiding pulmonary vein injury with careful planning of the needle pathway on CT and holding the ventilator during the puncture procedure may reduce the risk of air embolism.
METHODS: From June 2021 to October 2024, patients with suspicious lung nodule scheduled to elective surgery requiring intraoperative nodule localization in hybrid room were retrospectively studied. Lung nodule localization was performed under anaesthesia and intubation with computed tomography (CT) guidance, followed by repeat whole thorax scan to detect any complications. CT images were retrospectively evaluated by 2 radiologists and air embolism was defined as filling defect in main vessels or the heart.
RESULTS: A total of 1582 cases were reviewed, and 7 cases of air embolism (median age, 54 years; range, 36-68 years; 4 men) were detected, with an incidence of 0.44%. The median distance from the pleura to the target lesion was 25 mm (range, 10-60 mm). The median target lesion size was 8 mm (range, 6-15 mm). Identifiable vein branch adjacent to target nodule could be found in 6 (85.7%) patients. In 5 cases, air embolism was detected immediately after the procedure, while retrospectively revealed in 2 cases after surgery. Four (57.1%) patients developed related symptoms, including intraoperative cardiac arrest, blood pressure decline, postoperative hemiplegia, and visually impair. Cardiopulmonary resuscitation with chest compression was required in 2 patients. Adjustment to the Trendelenburg position was performed in 4 patients.
CONCLUSIONS: The increased risk of air embolism should be emphasized during intraoperative lung nodule localization in hybrid room, which might be related to the abnormal bronchial-vein fistula caused by the puncture and positive pressure ventilation. Avoiding pulmonary vein injury with careful planning of the needle pathway on CT and holding the ventilator during the puncture procedure may reduce the risk of air embolism.