VALUE AND LIMITS OF SELECTIVE BRONCHIAL I NTUBATION FOR THE TREATMENTOF SEVERE LOCALIZED PULMONARY INTERSTITIAL EMPHYSEMA IN NEONATES

Background. - Two methods of selective ventilation have been used for treating severe localized pulmonary emphysema in the neonates: control ateral selective intubation and selective bronchial obstruction. Case reports, - Three neonates with acute respiratory distress required res piratory support that was complicated by development of severe localiz ed pulmonary interstitial emphysema of the right lobe (two cases) and the middle lobe (one case). Selective bronchial obstruction with a Swa nn Ganz catheter SF was tentatively made: in one case, improvement was moderate and transitory, requiring middle lobectomy. The localized em physema disappeared within 3 days in the two other cases but a localiz ed emphysema appeared in the controlateral lung in one of them, requir ing left inferior lobectomy because the ineffectiveness of selective i ntubation or selective obstruction. Conclusion. - Selective bronchial obstruction may fail but this easy and well tolerated method should be tried in severe localized emphysema, specially in those patients who cannot be ventilated with high-frequency oscillation.