Acquired neonatal bronchial stenosis after selective intubation: Successful managed with balloon dilatation

Goussard, Pierre; Morrison, Julie; Bekker, Adrie; Fourie, Barend

doi:10.1002/ccr3.2112

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…Selective bronchial intubation of the nonaffected lung and selective bronchial occlusion of the affected lung are two additional treatment options described more often in other forms of neonatal air leak such as PIE, whose evidence is based on single case reports, and small case series [ 1 ]. However, the first seems to have a low success rate and an increased risk of complications such as hypoxia associated with reintubation and acquired bronchial stenosis [ 6 , 7 ]. In turn, successful selective bronchial occlusion has been reported in less than 30 cases of premature infants with different occlusion techniques [ 4 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant

et al. 2021

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Neonatal pulmonary air leak commonly occurs as a complication of mechanical ventilation in infants with underlying hyaline membrane disease. They can commonly be managed conservatively or with the application of a chest drain, but some severe cases pose a significant challenge in finding an alternative therapeutic solution. Selective bronchial occlusion represents an unconventional rescue therapy for treating bronchopleural fistula resistant to the standard therapy. A 27-week gestation preterm infant ventilated for respiratory distress syndrome developed tension right-sided pneumothorax. Conventional modalities of treatment were tried and were unsuccessful. Intermittent selective bronchial occlusion with a Fogarty’s catheter and high-frequency oscillatory ventilation resulted in considerable improvement in the infant’s clinical condition and radiographic findings.

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Section: Discussionmentioning

confidence: 99%

Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant

et al. 2021

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“…When using uncuffed tracheal tubes for selective endobronchial intubation according to published recommendation for size selection, the outer diameter of the tracheal tube may exceed the internal bronchial diameter, particularly on the left side. Therefore, careful insertion and re‐evaluation of tracheal tube size is mandatory to avoid mucosal bronchial injury resulting in bronchial stenosis 24 …”

Section: Discussionmentioning

confidence: 99%

Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children

Moser

Kemper

Dullenkopf

et al. 2020

Pediatric Anesthesia

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Background Cuffed tracheal tubes have recently been recommended for selective endobronchial intubation to establish single‐lung ventilation even in smaller children. This implies that, compared with uncuffed tracheal tubes, the cuffed tracheal tubes selected will be smaller and therefore have a shorter length. We hypothesized that cuffed tracheal tubes might be of insufficient length for selective endobronchial intubation if the tube cuff were fully immersed in the left or right mainstem bronchus. Methods The distance from the proximal end of the tracheal tube to the upper border of the cuff in cuffed tracheal tubes and to the upper margin of the Murphy eye in uncuffed tracheal tubes, respectively, was assessed in sizes 3.0–7.0 mm internal diameter. The raw data sets of two previously performed studies obtained from 337 children aged from birth to 16 years, including the distances “teeth to tracheal tube tip” and “tracheal tube tip to carina,” were used to calculate age‐, weight‐, and height‐related data for the distance from “teeth to carina.” Tracheal tube dimensions were compared with age‐related distances from “teeth to carina,” applying published recommendations for the selection of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children. Results The differences between the length of the age‐related tracheal tube and the tracheal tube insertion length required to guarantee full insertion of the tracheal tube cuff or the Murphy eye within the mainstem bronchus ranged from −3.5 to 52.6 mm in cuffed tracheal tubes and from 42.3 to 83.3 mm in uncuffed tracheal tubes. Conclusions For many age groups of patients requiring selective endobronchial intubation, the lengths of cuffed tracheal tubes, in contrast to those of uncuffed tracheal tubes, were revealed to be critically short for safe taping outside the oral cavity with the cuff placed completely within the right or left mainstem bronchus.

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“…The first description of balloon dilatation for tracheal and bronchial stenosis was in 1984. 27 Balloon dilatation can be done using different methods, including: through the working channel of the flexible bronchoscope; through rigid bronchoscopy; under direct vision with just a telescope; under fluoroscopy guidance [28][29][30][31][32] ; via laryngeal mask airway with an adult flexible bronchoscope 33 and via tracheostomy. 34,35 The most commonly used method of bronchial dilation is with an angioplasty balloon because these create a radial force against the airway and are less traumatic than a bougie.…”

Section: Pathogenesismentioning

confidence: 99%

Tuberculous bronchial stenosis: Diagnosis and role of interventional bronchoscopy

Goussard

Andronikou

Paed

et al. 2022

Pediatric Pulmonology

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The reported prevalence of tuberculous bronchial stenosis in children is unknown and rarely reported in English-speaking literature. In adult patients with pulmonary tuberculosis, it varies from 40% in an autopsied series in the preantibiotic era to 10% in patients who have undergone routine bronchofibroscopy in modern times. We describe our experience of four cases of confirmed bronchial stenosis due to MTB collected between January 2000 and June 2021 in this case series descriptive study.The diagnosis of bronchial stenosis due to TB was made on flexible bronchoscopy. A TB diagnosis was made if MTB was cultured from respiratory secretions, when Ziehl-Neelsen smear or GeneXpert MTB/RIF test was positive, or if a chest radiograph revealed radiographic features typical of MTB. Bronchial stenosis due to TB is rare even if airway compression is frequently seen. Although an early diagnosis of bronchial stenosis due to TB is difficult on chest X-rays, all children in this series demonstrated parenchymal changes distal to the stenosis ranging from hyperinflation and lobar collaps to bronchiectasis. If bronchial stenosis resulting from TB disease is diagnosed early, balloon dilatation as described in this report, may be an effective and safe intervention, preventing long-term complications such as irreversible lung destruction, that may require pneumonectomy.

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Acquired neonatal bronchial stenosis after selective intubation: Successful managed with balloon dilatation

Cited by 5 publications

References 5 publications

Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant

Selective Bronchial Occlusion for Treatment of a Bronchopleural Fistula in an Extremely Preterm Infant

Simulated dimensional compatibility of uncuffed and cuffed tracheal tubes for selective endobronchial intubation in children

Tuberculous bronchial stenosis: Diagnosis and role of interventional bronchoscopy

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