515 Selective Bronchial Intubation in Preterm Infants with Bullous Emphysema - a Series of 9 Cases

Abstract

Background and aims: Acquired bullous emphysema occurs in preterm infants as a sequela of BPD or of a mechanical valve gear mechanism. The characteristics is generalized air trapping or uneven distribution of gas with hyperlucent areas due to overdistended bronchioli or alveoli. There are only few case reports on selective one-sided lung ventilation as a therapeutic option.

Methods: Medical charts of preterm infants born between 1993 and 2010 with acquired bullous emphysema treated with selective bronchial intubation in our Division of Neonatology were reviewed. Gestational age, clinical history, clinical presentation, associated treatment methods, duration of ventilation and outcome of one-sided lung ventilation was recorded. Therapy was deemed successful if thereafter chest X ray showed a BPD < grade III according to Weinstein.

Results: Overall, 9 preterm infants with gestational age between 24 and 35 weeks and birth weight between 500 and 3170 g underwent one-sided lung ventilation. This was started between day 12 and 35 and was continued for 24 h to 7d. Selective intubation in 3 cases was done on the left side. 2 patients needed 2 courses of unilateral ventilation and 1 had 3 courses. Therapy was successful in 7 patients, who had no recurrence of the lobar emphysema.

Conclusion: Selective intubation, especial of the left bronchus, is technically challenging but seems to be practicable and helpful. If the affected lung lobe shows complete atelectasis for more than 48 h the overdistension of airways probably will resolve.

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