Selective intubation in pulmonary interstitial emphysema: experience in five patients.

Selective bronchial intubation can be useful in the management of severe localized pulmonary interstitial emphysema (PIE). Five infants between 9 and 20 days old with severe left sided PIE had the right main bronchus intubated for between 4 to 30 h. Four patients showed permanent and one patient temporary improvement and the experience from these cases suggests that prolonging the procedure after obtaining radiological evidence of improvement may not be necessary. There were no serious complications although right upper lobe atelectasis occurred in three cases and could not be prevented by using an endotracheal tube with a side hole. Nevertheless, active management should only be considered in PIE causing respiratory failure or pressure effects on surrounding structures.