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Diffuse persistent pulmonary interstitial emphysema secondary to mechanical ventilation in bronchiolitis.

Blanca Toledo Del Castillo^1,2, Isabel Gordillo³, Elena Rubio García⁴

¹Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Red de Investigación en Salud Materno-Infantil y del Desarrollo (Red SAMYD), C/ Doctor Castelo 47, 28009, Madrid, Spain. blankmajal@hotmail.com.

BMC Pulmonary Medicine

|November 5, 2016

Summary

Persistent interstitial pulmonary emphysema (PIE) is rare in full-term infants. Extracorporeal membrane oxygenation (ECMO) provided crucial lung healing support when other methods failed.

Keywords:

Diffuse persistent interstitial emphysema ECMO Mechanical ventilation Neonatal

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Published on: April 7, 2021

Area of Science:

Neonatal respiratory medicine
Pediatric critical care
Pulmonary imaging and diagnostics

Background:

Persistent interstitial pulmonary emphysema (PIE) is a rare condition, particularly in full-term neonates.
Mechanical ventilation, while life-saving, can precipitate or exacerbate PIE.
Management challenges arise when conservative strategies prove insufficient.

Observation:

An 18-day-old infant with bronchiolitis developed severe respiratory insufficiency requiring mechanical ventilation.
Imaging revealed a hyperinflated left lung with destructive changes, consistent with diffuse PIE.
The infant required advanced support including high-frequency oscillatory ventilation, inotropic agents, and renal replacement therapy.

Findings:

Despite initial ventilation strategies, the infant experienced cardiac arrest, necessitating cardiopulmonary resuscitation.
Extracorporeal membrane oxygenation (ECMO) was initiated for 5 days, facilitating lung protection and healing.
Progressive clinical improvement and radiographic normalization were observed during ECMO support.

Implications:

ECMO can be a life-saving intervention for severe, refractory PIE in neonates.
This case highlights the potential benefits of ECMO in facilitating lung recovery in critical neonatal respiratory failure.
Further research into optimal ventilation and ECMO strategies for PIE is warranted.