Resolution of pulmonary interstitial emphysema following selective left main stem intubation in a premature newborn: An old procedure revisited

Pulmonary interstitial emphysema (PIE) contributes to worsening respiratory status in already compromised premature infants. Various treatments for PIE include high-frequency ventilation, postural therapy, pneumonectomy or lobectomy and selective bronchial intubation. While right main stem bronchus intubation is easy to perform at the bedside for treatment of PIE in the left lung, left main stem bronchus intubation for the treatment of right-sided PIE remains challenging and the technique was rarely reported and poorly described. In this case report, we revisit this procedure and describe successful treatment of right lung PIE with hyperinflation by selective left main stem intubation at 2 weeks of life in a 24-week-old premature infant who had respiratory distress syndrome and pulmonary hemorrhage. A detailed description is given to allow clinical bedside replication following specific anatomic landmarks.