A 31-week-gestation baby girl, fourth-born of quadruplets, developed worsening right-side pulmonary interstitial emphysema (PIE) and pneumothoraces. On Day 23, when the baby's death appeared imminent, a modified endotracheal tube, with the end hole plugged with silicone adhesive and a side hole cut to face the left mainstem bronchus, was inserted in a rescue effort. Over the next 4 hours, blood gas values improved and a chest radiograph 4 hours after insertion showed right-side collapse (with resolution of PIE) and left-side overexpansion. Subsequent reintubation with a standard tube produced equal expansion and adequate blood gas values. The baby was weaned from mechanical ventilation over the next 3 weeks, extubated, and ultimately was discharged at 2 months of age, with some radiographic evidence of chronic lung disease. To our knowledge, the use of such a tube has not been described previously.
D'Ambola et al. (Thu,) studied this question.