Bronchoscopic Lung Insufflation and Surfactant Instillation for Post-Cardiac Surgery Atelectasis in a Neonate
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Abstract
Introduction: Persistent atelectasis in neonates can result in impaired gas exchange and prolonged morbidity when conservative measures fail. Bronchoscopic insufflation with surfactant instillation has recently been described as a promising therapeutic option.
Methods: We report the case of a neonate with persistent and treatment unresponsive atelectasis following arterial switch operation. The lung insufflation technique described by Šapina et al. was adapted by using a Neopuff manometer connected between the oxygen wall outlet and the bronchoscope working channel. Under light general anaesthesia with midazolam and propofol, a pediatric flexible bronchoscope was used to perform lavage, segmental insufflation, and instillation of surfactant.
Results: After three insufflation cycles to 30 cm H2O and surfactant administration in two aliquots, elective intubation was maintained for 24 hours to preserve lung recruitment. Post-procedure, the left lung was re-aerated with no evidence of pneumothorax.
Conclusion: This case demonstrates the feasibility and safety of bronchoscopic pressure-controlled insufflation combined with surfactant instillation in a neonate post-cardiac surgery, supporting its utility as described in recent literature.
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