How to manage an air embolus encountered after percutaneous biopsy?
Air embolism is a rare but life-threatening complication of lung biopsy, which can result in severe cardiac and neurologic events and death. Some postulate that air embolism occurs more frequently than suspected but goes undetected in asymptomatic patients. Air embolism should be suspected in patients with unexpected neurologic or cardiac events during a lung biopsy. Patients are placed on 100% oxygen via a nonrebreather mask or intubation, and supportive measures are implemented. Patient positioning remains controversial, where some practitioners advocate for placing the patient in a Trendelenburg (i.e., supine position with the feet more elevated than the head) and left lateral decubitus position to prevent gas from reaching the left ventricular outflow tract and the cerebral and coronary circulation. Others advocate for keeping patients supine to minimize movement and further migration of the gas. The most efficacious rescue therapy is the use of hyperbaric oxygen, which has been reported as successful by reducing intravascular bubble size, increasing oxygen diffusion into tissues, and decreasing the nitrogen content of the bubbles, facilitating the eventual resorption of the air.