Unilateral Lung Intubation for Pulmonary Air Leak Syndrome in Neonates: A Case Series and a Review of the Literature

ABSTRACT

Air leak syndrome represents a common set of complications of ventilated premature neonates and includes pneumothorax, pneumomediastinum, pulmonary interstitial emphysema, and pneumatocele. Unilateral intubation is an infrequently utilized treatment option. We report our experience of three cases of air leak syndrome in neonates, each treated with unilateral intubation, including two cases of recalcitrant pneumothorax. A review of the literature of similar neonatal cases is presented. In view of our experience and the review of the literature, we suggest that unilateral intubation is an efficient and relatively safe therapy in cases of neonatal air leak syndrome. It is also suggested that appropriate treatment duration should be at least 48 hours.

KEYWORDS

Unilateral intubation - pneumothorax - pneumatocele

REFERENCES

• 1 Andreou A, Papouli M, Netskos D, Papadopoulou F, Rossiou E. One-sided high-frequency oscillatory ventilation in the management of an acquired neonatal lobar emphysema: a case report and review.  J Perinatol. 2001;  21 61-64
• 2 Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 30-1997. A preterm newborn female triplet with diffuse cystic changes in the left lung.  N Engl J Med. 1997;  337 916-924
• 3 Messineo A, Fusaro F, Mognato G, Sabatti M, D'Amore E S, Guglielmi M. Lung volume reduction surgery in lieu of pneumonectomy in an infant with severe unilateral pulmonary interstitial emphysema.  Pediatr Pulmonol. 2001;  31 389-393
• 4 Chalak L F, Kaiser J R, Arrington R W. Resolution of pulmonary interstitial emphysema following selective left main stem intubation in a premature newborn: an old procedure revisited.  Paediatr Anaesth. 2007;  17 183-186
• 5 Yeh T F, Pildes R S, Salem M R. Treatment of persistent tension pneumothorax in a neonate by selective bronchial intubation.  Anesthesiology. 1978;  49 37-38
• 6 Mathew O P, Bhatia J. Management of persistent pneumothorax: an innovative approach.  J Pediatr. 1983;  103 117-119
• 7 Parish R A, Carroll W L, Kotagal U R. Selective right mainstem bronchus intubation as a treatment for persistent left pneumothorax in the newborn.  Clin Pediatr (Phila). 1983;  22 450-452
• 8 Meyer M T, Rice T B, Glaspey J C. Selective fiberoptic left main-stem intubation for severe unilateral barotrauma in a 24-week premature infant.  Pediatr Pulmonol. 2002;  33 227-231
• 9 Placzek M M, Young L W. Unilateral pulmonary interstitial emphysema and selective bronchial intubation.  Am J Dis Child. 1986;  140 161-162
• 10 Chan V, Greenough A. Severe localised pulmonary interstitial emphysema—decompression by selective bronchial intubation.  J Perinat Med. 1992;  20 313-316
• 11 Khashu M, Mawson J, Bhargava S, Singh A J. A newborn requiring selective bronchial intubation.  CMAJ. 2005;  173 872
• 12 Springer C, Amit Y, Eyal F. [Successful treatment of interstitial emphysema by selective intubation].  Harefuah. 1982;  102 421-423
• 13 Brooks J G, Bustamante S A, Koops B L et al.. Selective bronchial intubation for the treatment of severe localized pulmonary interstitial emphysema in newborn infants.  J Pediatr. 1977;  91 648-652
• 14 Vahey T N, Pratt G B, Baum R S. Treatment of Localized Pulmonary Interstitial Emphysema with Selective Bronchial Intubation . Treatment of localized pulmonary interstitial emphysema with selective bronchial intubation.  AJR Am J Roentgenol. 1983;  140 1107-1109
• 15 Mac Mahon P, Fleming P J, Thearle M J, Speidel B D. An improved selective bronchial intubation technique for managing severe localized interstitial emphysema.  Acta Paediatr Scand. 1982;  71 151-153
• 16 Campbell A N, Zarfin Y, Perlman M. Selective bronchial intubation for pulmonary emphysema.  Arch Dis Child. 1984;  59 890-892
• 17 Rettwitz-Volk W, Schlösser R, von Loewenich V. One-sided high-frequency oscillating ventilation in the treatment of neonatal unilateral pulmonary emphysema.  Acta Paediatr. 1993;  82 190-192
• 18 de Vries L S, Senders R C. Severe pulmonary interstitial emphysema of the right lung treated by selective intubation of the left main bronchus.  Intensive Care Med. 1984;  10 37-38
• 19 Oliver J E, Smith I J. Treatment of severe localized pulmonary interstitial emphysema by selective bronchial intubation.  Postgrad Med J. 1984;  60 58-59
• 20 Bowman E D, Murton L J. Selective intubation in pulmonary interstitial emphysema: experience in five patients.  Aust Paediatr J. 1984;  20 317-321
• 21 Dickman G L, Short B L, Krauss D R. Selective bronchial intubation in the management of unilateral pulmonary interstitial emphysema.  Am J Dis Child. 1977;  131 365
• 22 Randel R C, Mannino F L. One-lung high-frequency ventilation in the management of an acquired neonatal pulmonary cyst.  J Perinatol. 1989;  9 66-68
• 23 Chua R N, Yoder M C. Management of unilateral pulmonary cystic emphysema with selective bronchial intubation and high frequency jet ventilation in two infants.  Pediatr Pulmonol. 1990;  9 121-124
• 24 O'Donovan D, Wearden M, Adams J. Unilateral pulmonary interstitial emphysema following pneumonia in a preterm infant successfully treated with prolonged selective bronchial intubation.  Am J Perinatol. 1999;  16 327-331
• 25 Glenski J A, Thibeault D W, Hall F K, Hall R T, Germann D R. Selective bronchial intubation in infants with lobar emphysema: indications, complications, and long-term outcome.  Am J Perinatol. 1986;  3 199-204
• 26 Seibert J J, Dahlmann K, Hill D E. Selective left bronchial intubation for the treatment of pulmonary pseudocyst in the very premature infant.  J Pediatr Surg. 1984;  19 198-199
• 27 Holzki J, Kellner M. Life threatening unilateral pulmonary overinflation might be more successfully treated by contralateral selective intubation than by emergency pneumonectomy.  Paediatr Anaesth. 2003;  13 432-437