Selective bronchial intubation in infants with lobar emphysema: indications, complications, and long-term outcome

Thirteen infants underwent selective intubation of a mainstem bronchus (SBI) for lobar emphysema of varying etiologies. Seven infants had pulmonary interstitial emphysema (PIE) with lobar hyperinflation secondary to hyaline membrane disease and mechanical ventilation. Six of these improved with SBI and five maintained permanent resolution upon cessation of SBI. Two infants with localized areas of emphysema who were subsequently shown to have histologic evidence of bronchopulmonary dysplasia had unsuccessful SBI. SBI was also unsuccessful in permanently resolving congenital lobar emphysema although temporary collapse of the affected lobe occurred during SBI. Complications including hypoxia, bradycardia, right upper lobe atelectasis, pneumonia, and additional air leaks occurred during SBI in six cases. Follow-up xenon ventilation scans in four infants in whom SBI was successful revealed normal ventilation of the previously diseased lobes. SBI can be a useful alternative to surgical excision of the affected lobe in patients with localized lobar hyperinflation secondary to PIE. SBI is generally unsuccessful in permanently correcting congenital lobar emphysema, nor should it be used when chronic diffuse parenchymal damage is present.