Value and limits of selective bronchial intubation for the treatment of severe localized pulmonary interstitial emphysema in neonates (original) (raw)

1997, Archives De Pediatrie

R6sume Deux meihodes de ventilation selective ont~te proposees pour Ie traltement d'un emphyserne pulmonaire localise severe: I'intubation selective controlatc!mJe et l'obstruction selective du cOte attelnt parun catheter a ballonnet, Observal/ons. -Nous avons utilise cette derniere methode trois fois avec des resultats divers. Le catheter utilise etaitune sonde deSwann Ganz SF.Deux fois l'atteinte siegeail au lobe inf~rieur droit, une fois au lobe moyen droit. Dans un cas, l'amelloration n'a~te que uansltoire et une lobectcrnle a et~necessalre, Dans deux cas, la resolution complete de l'emphyseme a ete obtenue en 3[ours, Pour I'un de ces enfants, une recidive gauche n'a pu eire trait~e ni par obstruction selective, ni par intubation selective, et une lobectomie a elt effectuee. Concludon. -L'obstruction selective n'est pas toujours efJieace, mais c'est une technique simple et bien lolerec qui merite d'etre tentc!e enens d'emphyseme lobalre severe resistant~Inprise encharge habhuelle, emphjseme lnierstlllel unUat~rnll occlusion bronchlque s~lcclive I d~lrcssc mplratolre Summary -Value and limits or selecUve bronchial inlubatlon for the treatment or severe localized pulmonary Interstitial emphysema Inneonates, Background. -Two methods of selective ventilation have been used for treating severe localized pulmonary emphyselna in the neonates: contralateral selective intubation and selective hroncllial obstruction. Case reports. -Three neonates with acute respiratory distress required respiratory support tha: was compllcated by developmen: ojsevere localized pulmonary interstitial emphysel1U1 of theright lobe (11'0'0 cases) and the middle lobe (one case). Selective bronchial obstruction with aSwann Ganz catheter SFwas tentatively made: in one case, improvement was moderate and transitory, requiring middle lobectomy. The localiud emph)'sema disappeared within 3 days in the two other cases buta localized emph)'sema appeared in lhe contralateral lung in oneof them, requiring left inferior lobectomy because the intf!ecti~'eness of selectil'e intubation orselective obstruction. Conclusion. -Selective bronchial obstruction mayfailbutthis easy alUl well tolerated method should betried in severe localized emph)'sema, specia//)' in those patients who cannot be I'enti/ated with high-frequency oscillation, pulmonary emphysema I ventilation I respiratory distress syndrome I Infant I newborn I/o Correspondence et tires-tl-part,' E Gourrier, service tie medecine neonatale, hOpital Rene-Dubos, 6, avenue ile-de-France. 95301 Pontolse, France.