Unilateral Pulmonary Interstitial Emphysema Following Pneumonia in a Preterm Infant Successfully Treated with Prolonged Selective Bronchial Intubation

Abstract

We describe a ventilated preterm infant (26 week's gestation) who developed severe right-sided pulmonary interstitial emphysema following Staphylococcus aureus pneumonia. Prolonged selective bronchial intubation (10 days) resulted in a marked clinical improvement and resolution of the emphysema. Resolution of unilateral pulmonary interstitial emphysema may require a longer course of selective bronchial intubation than currently recommended.

Pulmonary Interstitial Emphysema Complicating Pneumonia in an Unventilated Term Infant

“…O'Donovan et al [3]. reported a ventilated preterm infant with acute unilateral PIE after staphylococcal pneumonia, who was treated with prolonged selective bronchial intubation and antibiotics.…”

“…Right-sided pneumothorax (arrowheads) and pneumomediastinum (thin arrows) are observed. Air-space consolidations and ground glass densities in the both lungs are noted selective bronchial occlusion, a short course of steroids, and high-frequency ventilation [3]. Surgical intervention may be considered for some persistent cases with resectable expansile lesions causing pulmonary dysfunction, cardiovascular compromise, recurrent infections or recurrent pneumothoraces, or for a definitive diagnosis in equivocal cases [8].…”

“…However, the occurrence of PIE associated with pneumonia has not been frequently reported [3,4]. There is only one case report of PIE in a full-term infant published, that was probably associated with a previous viral pneumonia [5].…”

Selective fiberoptic left main-stem intubation to treat bronchial laceration in an extremely low birth weight neonate

“…Selective bronchial intubation of extremely low birth weight neonates has been reported sporadically in the medical literature over the past three decades [8][9][10][11][12][13]. While these patients' histories and their procedural details are rather varied, in each case selective intubation was performed to treat severe, unilateral interstitial emphysema.…”

High-Frequency Oscillatory Ventilation with Low Oscillatory Frequency in Pulmonary Interstitial Emphysema

“…On conventional mechanical ventilation (CMV), this is facilitated by using short inspiratory times, low inflation pressures and small tidal volumes [5,7]. Lateral positioning [8,9] and/or selective main bronchial intubation [10,11,12] have been used for predominantly unilateral disease. Despite the use of these strategies, interstitial gas often persists, contributing to the requirement for prolonged mechanical ventilation [1].…”