Lung Isolation in a Small Airway: Fibreoptic-guided Endobronchial Intubation in a Child with Pleuropulmonary Blastoma

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Abstract Pleuropulmonary blastoma (PPB) is a rare and aggressive paediatric intrathoracic malignancy that may present with severe respiratory compromise and significant mediastinal shift. Achieving effective lung isolation during thoracic surgery in small children remains technically challenging because appropriately sized double-lumen tubes are often unavailable. We report the perioperative management of a 7-year-old child with histopathologically confirmed PPB Type III who presented with progressive respiratory distress and complete absence of right-sided air entry. Contrast-enhanced computed tomography revealed a large right-sided thoracic mass causing marked compression of the right lung with mediastinal shift. The child initially required stabilisation with high-flow nasal cannula (HFNC) support and subsequently received neoadjuvant chemotherapy before surgery. For right thoracotomy and lobectomy, lung isolation was achieved using fibreoptic-guided selective left endobronchial intubation with a 5.0 mm cuffed single-lumen endotracheal tube. One-lung ventilation was maintained using pressure-controlled ventilation with stable oxygenation and haemodynamics throughout the procedure. Following surgery, the endotracheal tube was repositioned into the trachea under fibreoptic guidance, and the patient was successfully extubated and shifted to the paediatric intensive care unit on HFNC support. This case highlights fibreoptic-guided selective endobronchial intubation as a practical and effective alternative for paediatric lung isolation in situations where dedicated paediatric lung isolation devices are unavailable.