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

Acquired pulmonary bullous emphysema is an infrequent complication of assisted ventilation in the premature infant that is difficult to manage. Objective: The goal of this report is to present the case of a premature infant who required selective bronchial intubation as well as to provide a review of the current literature on the subject. Clinical Case: The patient is a 27-week gestational age neonatal female patient whose clinical course was complicated by left unilateral bullous emphysema during assisted ventilation for respiratory distress syndrome. Lower peak inspiratory pressures, higher respiratory frequencies, patient positioning, and lower inspiration time failed to improve the patient's condition. The left lung became critically overinflated and compressed the right lung to the point of atelectasis. The patient was selectively mono intubated through the right main bronchus, which resulted in a collapse of the left emphysematous lung. Single right lung ventilation was continued for 48 hours before restarting conventional ventilation of both lungs. Our patient improved significantly, was extubated 6 days after the procedure and later discharged home with normal chest x-ray images. Conclusion: Selective bronchial intubation is a safe and effective procedure in cases of acquired bullous emphysema when usual ventilatory management fails.