What is the role of bronchial intubation in the treatment of pulmonary interstitial emphysema (PIE)?

Updated: Jun 25, 2019
  • Author: Abhay J Bhatt, MD, MBBS; Chief Editor: Muhammad Aslam, MD  more...
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Many case reports detail successful treatment of infants with severe localized pulmonary interstitial emphysema (PIE) by selective intubation of the contralateral bronchus. [32, 33, 34]  This maneuver decompresses the overdistended lung tissue and avoids exposing it to high positive inflationary pressures. Selective bronchial intubation of the right main bronchus is not a difficult procedure; the left side may be more difficult.

This procedure uses an endotracheal tube of the same diameter as for a regular intubation. However, the tube is inserted 2-4 cm beyond its usual position. It is introduced with the bevel on the end of the tube positioned so that the long part of the tube is toward the bronchus to be intubated. This increases the chance of the tube entering the correct bronchus as it is advanced into the airway. Turning the infant's head to the left or right moves the tip of the endotracheal tube to the contralateral side of the trachea and may help in selective tube placement.

Weintraub et al described a method for left selective bronchus intubation using a regular Portex endotracheal tube in which an elliptical hole 1 cm in length has been cut through half the circumference about 0.5 cm above the tip of the oblique distal end. [34]  By directing the side with the elliptical hole to the left lung, left selective bronchus intubation can be easily and repeatedly accomplished.

Another method of selective intubation is the use of a small fiberoptic bronchoscope to direct the endotracheal tube tip into the desired bronchus. Selective intubation under fluoroscopy can also be considered.

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