[Selective left mainstem bronchial intubation in the neonatal intensive care unit]

Area of Science:

• Neonatal respiratory management
• Pediatric critical care
• Airway management

Context:

• Selective intubation of the left mainstem bronchus is challenging in neonates due to bronchial anatomy.
• Current methods often require complex techniques and specialized equipment.

Purpose:

• To describe a simplified technique for selective left mainstem bronchial intubation in neonates.
• To provide an alternative to complex maneuvers for emergent airway management.

Summary:

• A modified endotracheal tube insertion technique, involving a 180° rotation and altered concavity orientation, facilitates selective left mainstem bronchial intubation.
• This method was successfully applied in a neonate with severe bullous emphysema requiring right lung non-ventilation.
• Tip position and tube concavity are key determinants for selective bronchial intubation.

Impact:

• This technique offers an accessible and rapid approach for selective intubation in critically ill neonates.
• It potentially reduces the need for advanced equipment like fiberoptic bronchoscopes or double-lumen endotracheal tubes.
• Facilitates timely management of unilateral lung pathology in neonatal intensive care settings.