A diagnostic bronchoscopy was performed on a 70-yr-old man who had had a lobectomy for
bronchogenic carcinoma three months earlier. During the direct insufflation of
oxygen into the right middle lobe bronchus, the patient became unresponsive and developed
subcutaneous emphysema. Immediately, an endotracheal tube and bilateral
chest tubes were placed with resultant improvement in his oxygen saturation. However, he remained unresponsive with extensor and flexor responses to
pain. Later, in the intensive care unit, he exhibited seizure activity requiring
anticonvulsant therapy. Sedation was utilized only briefly to facilitate controlled ventilation. Investigations revealed a negative computerized tomography (CT) scan of the head, a normal cerebral spinal fluid examination, a CT chest that showed evidence of
barotrauma, and an abnormal electroencephalogram. Fifty-two hours after the event, he was treated for presumed CAGE with hyperbaric
oxygen using a modified United States Navy Table 6. Twelve hours later he had regained consciousness and was extubated. He underwent two more hyperbaric treatments and was discharged from hospital one week after the event, fully recovered.
CONCLUSION: