CT-guided needle lung biopsy is possible during apneic oxygenation: a case series

Abstract

BackgroundIt can be difficult to perform CT guided biopsy of small pulmonary nodules especially if the position is behind a costa or close to the diaphragm and respiratory movements may hamper the procedure. During apneic oxygenation with a pulmonary standstill these movements can be hindered.MethodsSix patients with decreased lung function and suspicious lung nodules are presented. Under general anesthesia including a muscle relaxant and a cuffed tube in the trachea CT guided biopsy was prepared. Just before the biopsy the ventilation mode was switched to a continuous positive airway pressure of 5–10 cm H2O, maintaining 100% oxygen delivery without ventilation. If the position of the lung nodule was inconvenient for biopsy the pressure was increased to up to 17 cm H2O to expand the lungs to a better biopsy position. After retrieving the biopsy controlled ventilation was re-established and a finishing control CT-scan was performed. Blood gas analyses were performed with few minutes interval.ResultsAll biopsies were diagnostic. All patients survived the procedure with no major complications, but 3 patients developed pneumothorax. The length of apneic oxygenation was median 10 minutes (8–10 minutes). No major changes in vital parameters were observed, and in all patients the peripheral oxygen saturation was 100% throughout the procedure. The arterial oxygen tension rose to very high values and the lowest pH was 7.18.ConclusionsIt is possible to perform lung biopsies in selected patients with decreased lung function during apneic oxygenation in at least 10 minutes in a safe way.

Computed tomography guided lung biopsy under general anaesthesia with apnoea: Preliminary experience

“…Mean lesion size was 18 mm for GA patients, which is smaller than that seen in recent studies and significantly smaller compared to our local cohort (38 mm) undergoing LA biopsy. 2,8,13 Rate of pneumothorax for GA biopsies was 11% which is lower than our control group (42%). This is also lower than overall literature rates of~40%, and chest tube insertion in the GA group was 5.5% which is within literature range of up to 7%.…”

“…This is also lower than overall literature rates of~40%, and chest tube insertion in the GA group was 5.5% which is within literature range of up to 7%. 2,3,8,9,13 In the GA patient who required a chest tube, it is felt there was inadvertent positive pressure ventilation prior to the introducer needle being withdrawn and CT at 2 min post-needle withdrawal showed pneumothorax occupying a third of the hemithorax. The rate of peri-lesion haemorrhage was 33% in GA patients, also within literature quoted ranges (up to 40%) and similar to the control group (30%).…”

“…11 Thus, sampling nodules which are small, inferiorly placed and mobile or located near critical structures may prove technically challenging. 12,13 Critical structures include vessels, airways, mediastinum and diaphragm. CT fluoroscopy has been advocated in this scenario with real-time visualisation of needle trajectory.…”

“…This demonstrated that a limited period of apnoea under GA was safe. 13 We aim to further substantiate feasibility of the technique for technically challenging lung lesions by comparing to our local cohort of patients who underwent CTPLB under LA.…”

Four ways to ventilate during cardiopulmonary resuscitation in a porcine model: a randomized study

“…One method of securing high oxygenation and avoiding hypocapnia can be with apnoeic oxygenation, which in both animal experiments and in humans has been shown to give very high oxygenation for many minutes without CO 2 excretion. It is important to use pure oxygen because of the risk of accumulating nitrogen in the lungs with sudden desaturation [ 12 – 15 ].…”