BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchol...BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchologist should recognize this severe adverse event.Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.CASE SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following TBLB.Only a few cases of this rare complication were described previously.Our patient had an incidental finding of lung tumour and pulmonary emphysema.Cerebral air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia.Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later.Cerebral air embolism is an extremely rare complication of TBLB.This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSION Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after bronchoscopy.The current gold standard for diagnosis is computed tomography scan of the head.After recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.展开更多
BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable r...BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial.The system of long-term pulmonary rehabilitation care is insufficient.The main reasons for the absence of these outpatient programs are the lack of experience,the lack of interest of insurance companies in secondary prevention programs,and the lack of healthcare facilities in large geographical areas.The possibility of at-home pulmonary rehabilitation models(telemonitoring and telecoaching)could solve this problem.CASE SUMMARY A 71-year-old man with severe COPD,Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.Spirometry,body plethysmography,test of incremental respiratory endurance examination,6-min walking test,body mass index,airflow obstruction,dyspnea,exercise capacity index,and subjective perception of dyspnea were performed as part of the initial and final examination.The patient performed training at home,and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems.After 8 wk of home training,there was a significant increase in all monitored values:maximal inspiratory pressure,a novel parameter sustained maximal inspiratory pressure,forced expiratory volume in 1 s,total lung capacity,forced vital capacity,peak expiratory flow,and inspiratory capacity.There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale,an increase in exercise tolerance according to the 6-min walking test,and a decrease in the exercise capacity index as a predictor of prognosis.CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.展开更多
基金by The publication has been supported by Ministry of Health of the Czech Republic,No.MH CZ-DRO FNBr 65269705The Czech Pneumological and Phthisiological Society(open access publication fee grant).
文摘BACKGROUND In this case report we describe an extremely rare case of cerebral air embolism following transbronchial lung biopsy(TBLB).Only a few cases of this rare complication were described previously.Every bronchologist should recognize this severe adverse event.Prompt recognition of this complication is mandatory in order to initiate supportive measures and consider hyperbaric oxygen therapy.CASE SUMMARY In this case report we describe an extremely rare case of cerebral air embolism following TBLB.Only a few cases of this rare complication were described previously.Our patient had an incidental finding of lung tumour and pulmonary emphysema.Cerebral air embolism developed during bronchoscopy procedure,immediately after the third trans-bronchial lung biopsy sample and caused cerebral ischaemia of the right hemisphere and severe left-sided hemiplegia.Despite timely initiation of hyperbaric oxygen therapy hemiplegia didn´t resolve and the patient died several weeks later.Cerebral air embolism is an extremely rare complication of TBLB.This condition should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period since early recognition,diagnosis and hyperbaric oxygen therapy initiation are key factors determining the patient´s outcome.CONCLUSION Within this report,we conclude that air/gas embolism is an extremely rare complication after TBLB,which should be considered in case the patient remains unresponsive or presents with acute neurological symptoms in the postintervention period after bronchoscopy.The current gold standard for diagnosis is computed tomography scan of the head.After recognition of this complication we suggest immediate hyperbaric oxygen therapy,if available.
基金Ministry of Health of the Czech Republic(University Hospital Brno,65269705),No.NU21J-09-00004.
文摘BACKGROUND The prevalence of chronic obstructive pulmonary disease(COPD)is increasing worldwide,and at the same time it is associated with increased mortality and reduced quality of life.Efforts to build sustainable rehabilitation approaches to COPD treatment and prevention are crucial.The system of long-term pulmonary rehabilitation care is insufficient.The main reasons for the absence of these outpatient programs are the lack of experience,the lack of interest of insurance companies in secondary prevention programs,and the lack of healthcare facilities in large geographical areas.The possibility of at-home pulmonary rehabilitation models(telemonitoring and telecoaching)could solve this problem.CASE SUMMARY A 71-year-old man with severe COPD,Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.Spirometry,body plethysmography,test of incremental respiratory endurance examination,6-min walking test,body mass index,airflow obstruction,dyspnea,exercise capacity index,and subjective perception of dyspnea were performed as part of the initial and final examination.The patient performed training at home,and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems.After 8 wk of home training,there was a significant increase in all monitored values:maximal inspiratory pressure,a novel parameter sustained maximal inspiratory pressure,forced expiratory volume in 1 s,total lung capacity,forced vital capacity,peak expiratory flow,and inspiratory capacity.There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale,an increase in exercise tolerance according to the 6-min walking test,and a decrease in the exercise capacity index as a predictor of prognosis.CONCLUSION Respiratory telerehabilitation was greatly beneficial in a cooperative patient with COPD and may represent an alternative therapeutic approach to the increasing incidence of all lung diseases.
