One-lung Ventilation for Neonatal Pneumonectomy in a Hydropic Premature Infant: Fiberoptic-guided Left Mainstem Intubation
- 1Adıyaman University Faculty of Medicine, Department of Anaesthesiology and Reanimation, Adıyaman, Türkiye
- 2Adıyaman Training and Research Hospital, Clinic of Anaesthesiology and Reanimation, Adıyaman, Türkiye
Abstract
Congenital cystic adenomatoid malformation (CCAM) is a rare lung anomaly that can cause severe respiratory distress and hydrops fetalis. One-lung ventilation (OLV) in neonates poses extreme anatomical challenges due to the lack of appropriately sized double-lumen tubes or bronchial blockers. A male neonate (2500 g, 30 weeks’ gestation) presented with hydrops fetalis and a massive right-sided thoracic CCAM. Due to progressive respiratory failure and hemodynamic instability, an emergency right pneumonectomy was scheduled on postnatal day 3. To achieve OLV, a 3.5-mm cuffed endotracheal tube (with the cuff left deflated) was advanced into the left main bronchus under fiberoptic bronchoscopy (FOB) guidance. Removal of the tube adaptor facilitated rapid, pragmatic placement while minimizing interruptions to ventilation during apneic oxygenation. Pressure-controlled lung-protective ventilation was maintained. Transient desaturation episodes during mediastinal manipulation were successfully managed. The 3-hour procedure was completed without intraoperative complications. In premature neonates in whom commercial lung-isolation devices are impractical, FOB-guided selective mainstem bronchial intubation is a rapid, feasible, and effective strategy for OLV. Individualized airway planning and FOB guidance are instrumental in ensuring accurate placement and maintaining oxygenation.
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BibTeX
@article{bozkurt2026onelung,
title = {{One-lung Ventilation for Neonatal Pneumonectomy in a Hydropic Premature Infant: Fiberoptic-guided Left Mainstem Intubation}},
author = {Zeliha Bozkurt and Büşra G. Erol and Nezir Yılmaz},
journal = {Turkish Journal of Anaesthesiology and Reanimation},
year = {2026},
month = oct,
doi = {10.4274/tjar.2026.262718},
url = {https://doi.org/10.4274/tjar.2026.262718},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - One-lung Ventilation for Neonatal Pneumonectomy in a Hydropic Premature Infant: Fiberoptic-guided Left Mainstem Intubation
AU - Zeliha Bozkurt
AU - Büşra G. Erol
AU - Nezir Yılmaz
PY - 2026
DA - 2026/10/30
JO - Turkish Journal of Anaesthesiology and Reanimation
DO - 10.4274/tjar.2026.262718
UR - https://doi.org/10.4274/tjar.2026.262718
AB - Congenital cystic adenomatoid malformation (CCAM) is a rare lung anomaly that can cause severe respiratory distress and hydrops fetalis. One-lung ventilation (OLV) in neonates poses extreme anatomical challenges due to the lack of appropriately sized double-lumen tubes or bronchial blockers. A male neonate (2500 g, 30 weeks’ gestation) presented with hydrops fetalis and a massive right-sided thoracic CCAM. Due to progressive respiratory failure and hemodynamic instability, an emergency right pneumonectomy was scheduled on postnatal day 3. To achieve OLV, a 3.5-mm cuffed endotracheal tube (with the cuff left deflated) was advanced into the left main bronchus under fiberoptic bronchoscopy (FOB) guidance. Removal of the tube adaptor facilitated rapid, pragmatic placement while minimizing interruptions to ventilation during apneic oxygenation. Pressure-controlled lung-protective ventilation was maintained. Transient desaturation episodes during mediastinal manipulation were successfully managed. The 3-hour procedure was completed without intraoperative complications. In premature neonates in whom commercial lung-isolation devices are impractical, FOB-guided selective mainstem bronchial intubation is a rapid, feasible, and effective strategy for OLV. Individualized airway planning and FOB guidance are instrumental in ensuring accurate placement and maintaining oxygenation.
SN - 2667-677X
SN - 2667-6370
ER -