Management of severe right lung cystic pulmonary interstitial emphysema in an infant at 24 weeks gestation with bedside selective left main stem bronchial intubation: Case report and review of the literature

Article type: Case Report

Authors: Kanike, N.^a | Hospattankar, K.G.^a | Marotta, G.^b | Kumar, D.^{a; *}

Affiliations: [a] Pediatrics (Neonatology), Case Western Reserve University (CWRU), Metro Health Medical Center, Cleveland, OH, USA | [b] Otolaryngology Department, Case Western Reserve University (CWRU), Metro Health Medical Center, Cleveland, OH, USA

Correspondence: [*] Address for correspondence: Deepak Kumar, MD, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA. Tel.: +1 216 778 5946; Fax: +1 216 778 3252; E-mail: [email protected].

Abstract: Pulmonary interstitial emphysema (PIE) is a severe complication of mechanical ventilation in preterm infants. Selective bronchial intubation is a rarely used treatment strategy, as it is challenging, especially left main stem bronchial intubation. We report our experience in an infant at 24 weeks gestation with bedside left main stem bronchial intubation using flexible fiberoptic bronchoscopy. We also describe in detail the procedural details involved in the selective left main stem bronchial intubation including the helpful technique of gently bending the tip of the endotracheal tube to create “memory” to better direct the tube into the left main-stem bronchus while using the flexible fiberoptic bronchoscope. A review of the literature regarding selective bronchial intubation in newborn infants is presented. This case report and literature review suggest that bedside left main stem bronchial intubation using a flexible fiberoptic bronchoscope is a viable option to successfully manage even the most unstable extreme premature infant with unilateral right lung cystic PIE. This may potentially prevent a rare but necessary invasive surgical procedure like lobectomy or even death.

Keywords: Pulmonary interstitial emphysema, PIE, selective bronchial intubation, left main stem bronchial intubation, fiberoptic bronchoscopy, extremely preterm infant

DOI: 10.3233/NPM-180178

Journal: Journal of Neonatal-Perinatal Medicine, vol. 14, no. 2, pp. 299-305, 2021