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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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Balegar V KK, Barr PA, McCauley JC, Thomas G. Selective bronchial intubation in a preterm infant with congenital cystic adenomatoid malformation and pulmonary air leak syndrome. J Paediatr Child Health 2013; 49:E93-6. [PMID: 22845869 DOI: 10.1111/j.1440-1754.2012.02500.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A preterm infant with congenital cystic adenomatoid malformation (CCAM) who developed a right-sided pulmonary air leak syndrome (pulmonary interstitial emphysema and bronchopleural fistula) following CCAM resection is reported. The pulmonary air leak syndrome was successfully ameliorated by intubating the right mainstem bronchus using a modified endotracheal tube that allowed selective ventilation of the left lung. The procedure was used successfully as rescue treatment to control the pulmonary air leak and to confirm the functional adequacy of the left lung prior to definitive operative surgery.
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Affiliation(s)
- Kiran Kumar Balegar V
- Department of Neonatology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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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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Lewis S, Pelausa E, Ojah C, Paes B. Pulmonary interstitial emphysema: selective bronchial occlusion with a Swan-Ganz catheter. Arch Dis Child 1988; 63:313-5. [PMID: 3355216 PMCID: PMC1778794 DOI: 10.1136/adc.63.3.313] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A 26 week preterm infant ventilated for hyaline membrane disease developed severe pulmonary interstitial emphysema with extensive right sided bullous formation, mediastinal shift, and subsequent left sided atelectasis. A paediatric Swan-Ganz catheter was used for selective bronchial occlusion with dramatic improvement in the infant's clinical condition and radiographic findings.
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Affiliation(s)
- S Lewis
- Department of Paediatrics, McMaster University Health Sciences Centre, Chedoke-McMaster Hospital, Hamilton, Canada
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