Management of unilateral acquired pulmonary bullous emphysema in a premature infant through selective bronchial intubation. Case report and review of literature

Abstract

Unilateral acquired bullous emphysema is a rare pathology of the newborn, difficult to ventilate.

Objective: To describe a case that required selective bronchial intubation of the contralateral lung and review the literature.

Clinical Case: Premature newborn of 27 weeks old who evolves with unilateral left-sided bullous emphysema secondary to surfactant deficiency disease. The patient did not respond to the usual measures of positioning, decrease of maximum inspiratory pressures, respiratory rate and inspiratory time. It evolved severely, with high oxygen requirement, increasing distension of the affected lung and atelectasis of the contralateral lung. Monointubation of the right lung was performed, being the procedure well tolerated. After 48 hours, the affected lung was observed to have completely collapsed and the contralateral one was adequately insufflated, so it was decided to ventilate both lungs again. He progressed favorably, and was extubated six days after the procedure and was discharged with normal X-rays, without any cystic images being observed.

Conclusions: Selective mono-intubation has proven to be safe and efficient in cases of unilateral bullous emphysema when there is no response to the usual measures.