Steroid-induced resolution of refractory pulmonary interstitial emphysema

Abstract

Pulmonary interstitial emphysema (PIE) is a familiar complication of mechanical ventilation in premature infants. Its most severe form, marked by life-threatening respiratory and cardiovascular compromise, is a particularly vexing problem in neonatology. Treatment modalities rely on decubitus positioning and reduction of mean airway pressure, but refractory PIE is unresponsive to these maneuvers. Other options such as selective unilateral bronchial intubation, balloon catheter bronchial occlusion, selective lung volume reduction, and mechanical decompression each have clear limitations. In a patient with refractory, life-threatening PIE too unstable for other therapeutic modalities, we describe success with steroid therapy at a familiar dosing regimen.

Keywords:

• Hydrocortisone
• pneumothorax
• pulmonary interstitial emphysema
• respiratory distress syndrome
• steroids

Declaration of interest

We attest to no possible conflicts of interest, sources of financial support, corporate involvement, or patent holdings for each author in the preparation of this manuscript.

We attest to the fact that all authors listed on the title page (Sidharth Mahapatra and Brian Scottoline) have contributed to the manuscript in significant ways, attest to the validity and legitimacy of the data and its interpretation, and agree to its submission to The Journal of Maternal-Fetal & Neonatal Medicine.

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors