title: Selective unilateral lung ventilation in preterm infants with acquired bullous emphysema: a series of nine cases.
abstract: OBJECTIVE
  Immature lungs of preterm infants are particularly prone to overdistension from mechanical ventilation or continuous positive airway pressure. In these infants a localized pulmonary emphysema (PE) can develop. Conventional therapy regimens to resolve this process sometimes fail and especially in the case of bullous emphysema (BE) invasive procedures such as surgical resection of the affected lobe ultimately may be required. In the past few years we have applied selective one-sided lung ventilation, a nearly forgotten therapeutic option, in these infants with acquired BE.
  
  
  METHODS
  Medical charts of preterm infants in two Divisions of Neonatology, born between 1993 and 2010 with acquired BE treated with selective one-sided ventilation were reviewed. Gestational age, clinical presentation, course of disease, associated treatment, duration of ventilation and outcome of one-sided lung ventilation are recorded. Therapy was deemed successful if thereafter chest X-ray showed a permanent resolution of the BE and, in case of BPD, lung appearance was comparable to a grade < III according to Weinstein [Weinstein et al. Pediatr Pulmonol 1994; 18: 284-289].
  
  
  RESULTS
  Overall, nine preterm infants with a gestational age between 24 and 35 weeks and a birth weight between 500 and 3,170 g underwent one-sided lung ventilation. This intervention was started between day 12 and day 35 after birth and was continued for 24 hr to 7 days. In three cases selective intubation was performed on the left side. Two patients needed a second course of one-sided ventilation and one had three courses. Therapy was successful in seven patients, who had no recurrence of BE.
  
  
  CONCLUSIONS
  Selective one-sided intubation is technically challenging, in particular for the left bronchus, but seems to be feasible and helpful. If during selective intubation the affected lung lobe shows complete atelectasis for more than 48 hr the overdistension of airways probably will permanently resolve.
authors.affiliation: Department of Pediatric Cardiology, University Hospital of Freiburg, Freiburg, Germany. andre.jakob@uniklinik-freiburg.de
authors.forename: André
authors.initials: A
authors.lastname: Jakob
authors.forename: Christian
authors.initials: C
authors.lastname: Bender
authors.forename: Matthias
authors.initials: M
authors.lastname: Henschen
authors.forename: Ulrich
authors.initials: U
authors.lastname: Saueressig
authors.forename: Markus
authors.initials: M
authors.lastname: Uhl
authors.forename: Marcus
authors.initials: M
authors.lastname: Krüger
authors.forename: Peter
authors.initials: P
authors.lastname: Franck
authors.forename: Roland
authors.initials: R
authors.lastname: Hentschel
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D011656:Pulmonary Emphysema / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*