Overview
Perinatal interstitial emphysema (PIE) involves abnormal air dissection into the lung interstitium, often complicating neonatal respiratory conditions, leading to localized hyperinflation and potential respiratory compromise. 12Diagnosis
Clinical presentation includes respiratory distress, asymmetric chest movements, and sometimes pneumothorax.
Imaging studies (chest X-ray, CT) reveal characteristic hyperinflation and air cysts in affected lung regions.
Bronchoscopy may confirm the presence of air leaks into the interstitium. 12Management
First-line treatments: Mechanical ventilation adjustments, ensuring optimal airway pressure settings.
Selective bronchial intubation: For unilateral severe PIE, selective intubation of the unaffected bronchus can alleviate hyperinflation effectively. 12
Adjunctive techniques: Use of specialized endotracheal tubes with additional side holes to manage complications like right upper lobe collapse. 2Special Populations
Pediatrics: Selective bronchial intubation techniques are particularly noted in neonates and infants with severe localized PIE. 12Key Recommendations
Consider selective intubation of the contralateral main bronchus as a non-surgical intervention for unilateral severe PIE when conservative measures fail to resolve hyperinflation. (Evidence: Moderate) 1
Employ specialized endotracheal tubes with additional side holes to manage complications such as lobe collapse during selective bronchial intubation in neonates. (Evidence: Weak) 2
Prioritize non-surgical approaches like selective bronchial intubation before considering surgical intervention to preserve lung tissue function in severe unilateral PIE cases. (Evidence: Expert opinion) 1References
1 de Vries LS, Senders RC. Severe pulmonary interstitial emphysema of the right lung treated by selective intubation of the left main bronchus. Intensive care medicine 1984. link
2 Mac Mahon P, Fleming PJ, Thearle MJ, Speidel BD. An improved selective bronchial intubation technique for managing severe localized interstitial emphysema. Acta paediatrica Scandinavica 1982. link