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Selective bronchial intubation in infants with lobar emphysema: indications, complications, and long-term outcome

J A Glenski, D W Thibeault, F K Hall

    American Journal of Perinatology
    |July 1, 1986
    PubMed

    Insights

    Selective mainstem bronchus intubation (SBI) effectively treated lobar emphysema in infants with pulmonary interstitial emphysema (PIE). However, SBI was less successful for congenital lobar emphysema or bronchopulmonary dysplasia.

    Area of Science:

    • Pediatric Pulmonology
    • Thoracic Surgery
    • Neonatology

    Background:

    • Lobar emphysema in infants presents with varying etiologies and can lead to severe respiratory distress.
    • Pulmonary interstitial emphysema (PIE) with lobar hyperinflation, often secondary to hyaline membrane disease and mechanical ventilation, poses a significant clinical challenge.
    • Congenital lobar emphysema and bronchopulmonary dysplasia represent distinct entities requiring specific management strategies.

    Purpose of the Study:

    • To evaluate the efficacy and outcomes of selective mainstem bronchus intubation (SBI) in infants with lobar emphysema.
    • To determine the success rates of SBI across different etiologies of lobar emphysema, including PIE, congenital lobar emphysema, and bronchopulmonary dysplasia.
    • To identify potential complications associated with SBI in the neonatal population.

    Main Methods:

    • Retrospective review of thirteen infants undergoing selective mainstem bronchus intubation (SBI) for lobar emphysema.
    • Categorization of patients based on the underlying etiology of lobar emphysema (PIE, congenital lobar emphysema, bronchopulmonary dysplasia).
    • Assessment of clinical improvement, need for ongoing intervention, and complications during and after SBI.

    Main Results:

    • Selective mainstem bronchus intubation (SBI) led to improvement in six of seven infants with pulmonary interstitial emphysema (PIE), with five achieving permanent resolution.
    • SBI was unsuccessful in permanently resolving congenital lobar emphysema and showed limited success in infants with bronchopulmonary dysplasia.
    • Complications during SBI occurred in six cases, including hypoxia, bradycardia, atelectasis, pneumonia, and air leaks. Follow-up ventilation scans showed normal lobe ventilation in successful cases.

    Conclusions:

    • Selective mainstem bronchus intubation (SBI) is a viable alternative to surgery for localized lobar hyperinflation secondary to PIE in infants.
    • SBI is generally ineffective for permanent correction of congenital lobar emphysema and should be avoided in cases of chronic diffuse lung damage.
    • Careful patient selection is crucial for optimizing outcomes and minimizing risks associated with SBI in neonatal respiratory conditions.

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