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Johansen M, Veyckemans F, Engelhardt T. Congenital anomalies of the large intrathoracic airways. Paediatr Anaesth 2022; 32:126-137. [PMID: 34797930 DOI: 10.1111/pan.14339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/03/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
Congenital lung lesions are numerous but rare in individual clinical practice. They do require close multidisciplinary collaboration between health care professionals. This educational review will focus on the pathophysiology, clinical manifestations, surgical approaches, and anesthetic management of congenital anomalies of the large intrathoracic airways: congenital tracheal stenosis, tracheal agenesis, tracheal diverticulum, bronchial anomalies (tracheal, esophageal, or bridging bronchus), congenital lung malformations, lung sequestrations and Scimitar syndrome, lobar emphysema, Williams-Campbell syndrome, and pleuropulmonary blastoma. In addition, this review will illustrate common pitfalls and challenges related to the anesthesia management with emphasis on ventilation and correct endotracheal tube positioning.
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Affiliation(s)
- Mathias Johansen
- Department of Paediatric Anaesthesiology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Francis Veyckemans
- Clinique d'Anesthésie Pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, Lille, France
| | - Thomas Engelhardt
- Department of Paediatric Anaesthesiology, Montreal Children's Hospital, Montreal, Quebec, Canada
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2
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Inage Y, Kumazawa K, Mori T, Tanabe Y, Kobayashi M. Selective bronchial occlusion as treatment for pulmonary interstitial emphysema. Pediatr Int 2022; 64:e14848. [PMID: 34747099 DOI: 10.1111/ped.14848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/21/2021] [Accepted: 05/12/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Yuka Inage
- Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Japan
| | - Kensuke Kumazawa
- Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Japan
| | - Takuma Mori
- Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Japan
| | - Yukitoshi Tanabe
- Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Japan
| | - Masahisa Kobayashi
- Department of Pediatrics, The Jikei University School of Medicine, Minato-ku, Japan
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Amelio GS, Colnaghi M, Gulden S, Raffaeli G, Cortesi V, Amodeo I, Cavallaro G, Mosca F, Ghirardello S. Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant. CHILDREN 2021; 8:children8121208. [PMID: 34943403 PMCID: PMC8700577 DOI: 10.3390/children8121208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 11/16/2022]
Abstract
Neonatal pulmonary air leak commonly occurs as a complication of mechanical ventilation in infants with underlying hyaline membrane disease. They can commonly be managed conservatively or with the application of a chest drain, but some severe cases pose a significant challenge in finding an alternative therapeutic solution. Selective bronchial occlusion represents an unconventional rescue therapy for treating bronchopleural fistula resistant to the standard therapy. A 27-week gestation preterm infant ventilated for respiratory distress syndrome developed tension right-sided pneumothorax. Conventional modalities of treatment were tried and were unsuccessful. Intermittent selective bronchial occlusion with a Fogarty’s catheter and high-frequency oscillatory ventilation resulted in considerable improvement in the infant’s clinical condition and radiographic findings.
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Affiliation(s)
- Giacomo Simeone Amelio
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.A.); (M.C.); (S.G.); (G.R.); (V.C.); (I.A.); (F.M.); (S.G.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Mariarosa Colnaghi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.A.); (M.C.); (S.G.); (G.R.); (V.C.); (I.A.); (F.M.); (S.G.)
| | - Silvia Gulden
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.A.); (M.C.); (S.G.); (G.R.); (V.C.); (I.A.); (F.M.); (S.G.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.A.); (M.C.); (S.G.); (G.R.); (V.C.); (I.A.); (F.M.); (S.G.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Valeria Cortesi
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.A.); (M.C.); (S.G.); (G.R.); (V.C.); (I.A.); (F.M.); (S.G.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Ilaria Amodeo
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.A.); (M.C.); (S.G.); (G.R.); (V.C.); (I.A.); (F.M.); (S.G.)
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.A.); (M.C.); (S.G.); (G.R.); (V.C.); (I.A.); (F.M.); (S.G.)
- Correspondence: ; Tel.: +39-02-5503-2907; Fax: +39-02-5503-2429
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.A.); (M.C.); (S.G.); (G.R.); (V.C.); (I.A.); (F.M.); (S.G.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.S.A.); (M.C.); (S.G.); (G.R.); (V.C.); (I.A.); (F.M.); (S.G.)
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Kanike N, Hospattankar KG, Marotta G, Kumar D. Management of severe right lung cystic pulmonary interstitial emphysema in an infant at 24 weeks gestation with bedside selective left main stem bronchial intubation: Case report and review of the literature. J Neonatal Perinatal Med 2021; 14:299-305. [PMID: 32986686 DOI: 10.3233/npm-180178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pulmonary interstitial emphysema (PIE) is a severe complication of mechanical ventilation in preterm infants. Selective bronchial intubation is a rarely used treatment strategy, as it is challenging, especially left main stem bronchial intubation. We report our experience in an infant at 24 weeks gestation with bedside left main stem bronchial intubation using flexible fiberoptic bronchoscopy. We also describe in detail the procedural details involved in the selective left main stem bronchial intubation including the helpful technique of gently bending the tip of the endotracheal tube to create "memory" to better direct the tube into the left main-stem bronchus while using the flexible fiberoptic bronchoscope. A review of the literature regarding selective bronchial intubation in newborn infants is presented. This case report and literature review suggest that bedside left main stem bronchial intubation using a flexible fiberoptic bronchoscope is a viable option to successfully manage even the most unstable extreme premature infant with unilateral right lung cystic PIE. This may potentially prevent a rare but necessary invasive surgical procedure like lobectomy or even death.
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Affiliation(s)
- N Kanike
- Pediatrics (Neonatology), Case Western Reserve University (CWRU), Metro Health Medical Center, Cleveland, OH, USA
| | - K G Hospattankar
- Pediatrics (Neonatology), Case Western Reserve University (CWRU), Metro Health Medical Center, Cleveland, OH, USA
| | - G Marotta
- Otolaryngology Department, Case Western Reserve University (CWRU), Metro Health Medical Center, Cleveland, OH, USA
| | - D Kumar
- Pediatrics (Neonatology), Case Western Reserve University (CWRU), Metro Health Medical Center, Cleveland, OH, USA
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Vargas-Pons L, Navarrete LV, Pérez SS, Casas EG, Lozano NB, Valdovinos LR, Collado RC. A Case of Persistent Air Leak Managed by Selective Left Main Bronchus Intubation in an Infant with Pulmonary Tuberculosis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920453. [PMID: 31902940 PMCID: PMC6977608 DOI: 10.12659/ajcr.920453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persistent air leak, or persistent pneumothorax, is defined as a pneumothorax that persists beyond the first week, or air leak through a chest drain for more than 48 hours. The most common findings in pediatric pulmonary tuberculosis are parenchymal disease and mediastinal lymphadenopathy, but airway obstruction can cause emphysema and pneumothorax. A case is presented of persistent air leak in a 3-month-old infant with pulmonary tuberculosis that was managed by selective left main bronchus intubation. CASE REPORT A 3-month-old boy presented with respiratory distress and fever. Imaging findings suggested pulmonary tuberculosis, and first-line anti-tuberculous treatment was initiated with isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE). He was discharged home after eight days, but was admitted four days later with respiratory distress. Chest X-rays showed a tension pneumothorax that required drainage and chest computed tomography (CT) showed right lung emphysema. Bronchoscopy found extrinsic obstruction of both main bronchi. Chest drains continued to leak air leak after 48 h. Right middle and lower lobectomy and drainage of multiple lymph nodes resulted in significant improvement. He developed pneumonia and acute respiratory distress syndrome, which prevented mechanical ventilation. The left main bronchus was selectively intubated to allow the air leak to heal and to ventilate the lung. He was extubated 10 days later and recovered completely. CONCLUSIONS This case highlights that when medical management of persistent air leak associated with tuberculosis is not effective, surgery, active ventilation, and selective main bronchus intubation should be considered.
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Affiliation(s)
- Laura Vargas-Pons
- Pediatric Pneumology Unit, Parc Taulí University Hospital, Institute of Research and Annovation, Autonomous University of Barcelona, Sabadell, Spain
| | - Laura Valdesoiro Navarrete
- Pediatric Pneumology Unit, Parc Taulí University Hospital, Institute of Research and Annovation, Autonomous University of Barcelona, Sabadell, Spain
| | - Sílvia Sánchez Pérez
- Pediatric Intensive Care Unit, Parc Taulí University Hospital, Institute of Research and Annovation, Autonomous University of Barcelona, Sabadell, Spain
| | | | - Nuria Brun Lozano
- Department of Pediatric Surgery, Parc Taulí University Hospital, Institute of Research and Annovation, Autonomous University of Barcelona, Sabadell, Spain
| | - Luis Renter Valdovinos
- Pediatric Intensive Care Unit, Parc Taulí University Hospital, Institute of Research and Annovation, Autonomous University of Barcelona, Sabadell, Spain
| | - Raquel Corripio Collado
- Department of Pediatric Endocrinology, Parc Taulí University Hospital, Autonomous University of Barcelona, Sabadell, Spain
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Jakob A, Hentschel R. Air leaks and pulmonary emphysema in infants: selective bronchial intubation or balloon occlusion? Arch Dis Child 2013; 98:649. [PMID: 23676528 DOI: 10.1136/archdischild-2013-303752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jakob A, Bender C, Henschen M, Saueressig U, Uhl M, Krüger M, Franck P, Hentschel R. Selective unilateral lung ventilation in preterm infants with acquired bullous emphysema: a series of nine cases. Pediatr Pulmonol 2013; 48:14-9. [PMID: 22431428 DOI: 10.1002/ppul.22530] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 01/24/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIMS Immature lungs of preterm infants are particularly prone to overdistension from mechanical ventilation or continuous positive airway pressure. In these infants a localized pulmonary emphysema (PE) can develop. Conventional therapy regimens to resolve this process sometimes fail and especially in the case of bullous emphysema (BE) invasive procedures such as surgical resection of the affected lobe ultimately may be required. In the past few years we have applied selective one-sided lung ventilation, a nearly forgotten therapeutic option, in these infants with acquired BE. METHODS Medical charts of preterm infants in two Divisions of Neonatology, born between 1993 and 2010 with acquired BE treated with selective one-sided ventilation were reviewed. Gestational age, clinical presentation, course of disease, associated treatment, duration of ventilation and outcome of one-sided lung ventilation are recorded. Therapy was deemed successful if thereafter chest X-ray showed a permanent resolution of the BE and, in case of BPD, lung appearance was comparable to a grade < III according to Weinstein [Weinstein et al. Pediatr Pulmonol 1994; 18: 284-289]. RESULTS Overall, nine preterm infants with a gestational age between 24 and 35 weeks and a birth weight between 500 and 3,170 g underwent one-sided lung ventilation. This intervention was started between day 12 and day 35 after birth and was continued for 24 hr to 7 days. In three cases selective intubation was performed on the left side. Two patients needed a second course of one-sided ventilation and one had three courses. Therapy was successful in seven patients, who had no recurrence of BE. CONCLUSIONS Selective one-sided intubation is technically challenging, in particular for the left bronchus, but seems to be feasible and helpful. If during selective intubation the affected lung lobe shows complete atelectasis for more than 48 hr the overdistension of airways probably will permanently resolve.
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Affiliation(s)
- André Jakob
- Department of Pediatric Cardiology, University Hospital of Freiburg, Freiburg, Germany.
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Watanabe M, Momoi N, Sato M, Go H, Imamura T, Kaneko M, Hosoya M. Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report. J Med Case Rep 2012; 6:325. [PMID: 23013845 PMCID: PMC3492090 DOI: 10.1186/1752-1947-6-325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/27/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction Pulmonary interstitial emphysema is a serious complication of mechanical ventilation and can become life-threatening if progression occurs. Therapeutic lung puncture is a treatment option for severe pulmonary interstitial emphysema but has a limited use in babies with extremely low birth weight. We present a case of pulmonary interstitial emphysema in a Japanese baby (1-day-old) boy with extremely low birth weight. The emphysema was successfully decompressed by therapeutic lung puncture performed with a trocar catheter. Case presentation The baby was born with a weight of 420g, which, to the best of our knowledge, is the lowest reported birth weight among babies with pulmonary interstitial emphysema. A chest X-ray on postnatal day 2 revealed pulmonary interstitial emphysema, which gradually progressed to diffuse pseudocystic changes. His condition became life-threatening despite the use of high-frequency oscillatory ventilation and lateral decubitus positioning. We evacuated the pulmonary interstitial emphysema by lung puncture with a trocar catheter to avoid respiratory and cardiovascular collapse. This resulted in adequate evacuation of the emphysema and a dramatic improvement in his clinical condition. Conclusions Therapeutic lung puncture performed with a trocar catheter is beneficial in babies with extremely low birth weight and diffuse pulmonary interstitial emphysema. This treatment option may be broadly applicable, especially in an emergency situation.
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Affiliation(s)
- Masahiro Watanabe
- Department of Pediatrics, Fukushima Medical University, 1st Hikarigaoka, Fukushima, 960-1295, Japan.
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Rastogi S, Gupta A, Wung JT, Berdon WE. Treatment of giant pulmonary interstitial emphysema by ipsilateral bronchial occlusion with a Swan-Ganz catheter. Pediatr Radiol 2007; 37:1130-4. [PMID: 17882412 DOI: 10.1007/s00247-007-0597-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 06/12/2007] [Accepted: 07/13/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Unilateral giant pulmonary interstitial emphysema (PIE) can be seen as a complication of chronic ventilation in extremely low-birth-weight babies. Many can be managed by conventional pulmonary care which includes positioning, suctioning, chest physiotherapy, gentle conventional ventilation and high-frequency ventilation. Some may need invasive procedures such as lung puncture, pleurotomies and excisional surgery. This is the group in which single-lung ventilation may be beneficial and circumvent the need for an invasive procedure. OBJECTIVE We describe the technique of single-lung ventilation using a Swan-Ganz catheter to block the main stem bronchus on the diseased side in air-leak syndromes. MATERIALS AND METHODS A retrospective chart review was done on 17 newborns undergoing single-lung ventilation using this technique at the Children's Hospital of New York, Columbia University, from 1986 to 2000. RESULTS The technique was successful in the management of severe, neonatal unilateral lung disease not responsive to conventional modes of therapy in all but two neonates as seen by a significant improvement in pH and a decrease in PaCO(2) levels. In one neonate malpositioning of the Swan-Ganz catheter balloon could have contributed to the development of pneumothorax. CONCLUSION The described technique of single-lung ventilation provides a safe, minimally invasive and economically feasible method of management of unilateral giant PIE in newborns not responsive to conventional modes of therapy with minimal complications.
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Affiliation(s)
- Shantanu Rastogi
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of New York, College of Physicians & Surgeons, Columbia University, New York, NY, USA.
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Alwadai A, Alturki A. Selective contralateral balloon occlusion for successful opening of a persistently collapsed lung in congenital lobar emphysema. Ann Saudi Med 2006; 26:313-4. [PMID: 16885629 PMCID: PMC6074498 DOI: 10.5144/0256-4947.2006.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Abdullah Alwadai
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Gourrier E, Phan F, Wood C, Mokhtari M, Chenel C. [Value and limits of selective bronchial obstruction in neonatal unilateral interstitial emphysema]. Arch Pediatr 1997; 4:751-4. [PMID: 9337898 DOI: 10.1016/s0929-693x(97)83414-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Two methods of selective ventilation have been used for treating severe localized pulmonary emphysema in the neonates: controlateral selective intubation and selective bronchial obstruction. CASE REPORTS Three neonates with acute respiratory distress required respiratory support that was complicated by development of severe localized pulmonary interstitial emphysema of the right lobe (two cases) and the middle lobe (one case). Selective bronchial obstruction with a Swann Ganz catheter SF was tentatively made: in one case, improvement was moderate and transitory, requiring middle lobectomy. The localized emphysema disappeared within 3 days in the two other cases but a localized emphysema appeared in the controlateral lung in one of them, requiring left inferior lobectomy because the ineffectiveness of selective intubation or selective obstruction. CONCLUSION Selective bronchial obstruction may fail but this easy and well tolerated method should be tried in severe localized emphysema, specially in those patients who cannot be ventilated with high-frequency oscillation.
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Affiliation(s)
- E Gourrier
- Service de réanimation pédiatrique polyvalente, hôpital Saint-Vincent-de-Paul, Paris, France
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Mosca F, Lattanzio M, Colnaghi MR, Pugliese S. Bronchopleural fistula: successful selective bronchial occlusion with a Fogarty's catheter in a preterm infant. Acta Paediatr 1995; 84:1079-82. [PMID: 8652965 DOI: 10.1111/j.1651-2227.1995.tb13831.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A preterm infant (26 weeks' gestation) mechanically ventilated for respiratory distress syndrome developed severe interstitial emphysema of the right lung with a bronchopleural fistula, pneumothorax and mediastinal shift. Selective occlusion of the right main bronchus with a Fogarty's catheter produced rapid improvement in the clinical condition and radiological features. Occlusion of the main bronchus in a newborn with a bronchopleural fistula and pulmonary interstitial emphysema is an easily performed manoeuvre that can be life-saving.
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Affiliation(s)
- F Mosca
- Department of Obstetrics and Gynaecology, L Mangiagalli, University of Milan, Italy
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al Jishi N, Dyer D, Sharief N, al-Alaiyan S. Selective bronchial occlusion for treatment of bullous interstitial emphysema and bronchopleural fistula. J Pediatr Surg 1994; 29:1545-7. [PMID: 7877023 DOI: 10.1016/0022-3468(94)90211-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A preterm infant, ventilated for hyaline membrane disease, had severe right-sided pulmonary interstitial emphysema, left-sided compression atelectasis, and bronchopleural fistula. Several modalities of treatment were tried and were unsuccessful. Selective bronchial occlusion with a balloon catheter resulted in dramatic improvement in the patient's clinical and radiographic condition.
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Affiliation(s)
- N al Jishi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
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