Treatment of giant pulmonary interstitial emphysema by ipsilateral bronchial occlusion with a Swan-Ganz catheter.
BACKGROUND
Unilateral giant pulmonary interstitial emphysema (PIE) can be seen as a complication of chronic ventilation in extremely low-birth-weight babies. Many can be managed by conventional pulmonary care which includes positioning, suctioning, chest physiotherapy, gentle conventional ventilation and high-frequency ventilation. Some may need invasive procedures such as lung puncture, pleurotomies and excisional surgery. This is the group in which single-lung ventilation may be beneficial and circumvent the need for an invasive procedure.


OBJECTIVE
We describe the technique of single-lung ventilation using a Swan-Ganz catheter to block the main stem bronchus on the diseased side in air-leak syndromes.


METHODS
A retrospective chart review was done on 17 newborns undergoing single-lung ventilation using this technique at the Children's Hospital of New York, Columbia University, from 1986 to 2000.


RESULTS
The technique was successful in the management of severe, neonatal unilateral lung disease not responsive to conventional modes of therapy in all but two neonates as seen by a significant improvement in pH and a decrease in PaCO(2) levels. In one neonate malpositioning of the Swan-Ganz catheter balloon could have contributed to the development of pneumothorax.


CONCLUSIONS
The described technique of single-lung ventilation provides a safe, minimally invasive and economically feasible method of management of unilateral giant PIE in newborns not responsive to conventional modes of therapy with minimal complications.
Rastogi
Shantanu
S
Division of Neonatology, Department of Pediatrics, The Children's Hospital of New York, College of Physicians & Surgeons, Columbia University, New York, NY, USA. srastogi@maimonidesmed.org
Gupta
Archana
A
Wung
Jen-Tien
JT
Berdon
Walter E
WE
D002406:Catheterization, Peripheral / Q000379:methods*; D002407:Catheterization, Swan-Ganz / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000628:therapy*; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome