Background

Pulmonary interstitial emphysema (PIE) results from overdistention and rupture of the alveoli. PIE is a complication usually associated, although not exclusively, with mechanical ventilation in preterm newborns. Unilateral emphysema causes mediastinal shift and compression of the contralateral lung, which leads to higher ventilatory pressures, overdistension and a worsening cycle of events.

Objectives

The goal of this paper was to present a sucessful aproach of PIE by selective ventilation

Methods

The authors present a case report of a female preterm born at 28 weeks of gestation from caesarian delivery due to maternal pre-eclampsia.

Results

Female preterm with a birthweight of 875 grams (appropriate for gestational age). Due to respiratory distress syndrome nasal-biphasic positive airway pressure was initiated and two doses of surfactant were administered. On day two, she developed a left-sided hypertensive pneumothorax, which led to intubation and drainage with a chest tube. In the following days there was respiratory deterioration, with hyperinflation of the left lung and the need for multiple chest tubes.

On day 20 the chest x-ray showed severe PIE and compression of the right lung, confirmed by CT scan (image 1 and 2). Selective right bronchial intubation and right lung ventilation was decided with clinical improvement. Endotracheal tube was withdrawn to mid-tracheal position on day 34. She was successfully extubated on day 36, remaining clinically stable.

Conclusion

Selective intubation and ventilation of the contralateral lung has been described as a treatment option for unilateral pulmonary emphysema as it enables the affected lung to recover leading to lower risk for baro and volutrauma.