Airway and Ventilatory Management Options in Congenital Tracheoesophageal Fistula Repair

Ho, Anthony M.‐H.; Dion, Joanna M.; Wong, Joyce Chau Ping

doi:10.1053/j.jvca.2015.04.005

Cited by 25 publications

(19 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These alarming episodes may be caused partly by compression or kinking during right hemithorax insufflation of the trachea, bronchi, and TEF. Also, the increased intrathoracic pressure can decrease venous return [6]. Generally, low ETCO 2 always emerges with low tidal volume and high airway pressure.…”

Section: Discussionmentioning

confidence: 99%

“…When low ETCO 2 occurs with normal tidal volume and normal airway pressure, decrease venous return should be highly suspected. Repeated gentle, partial reexpansion of the right lung by brief easing of retraction and release of the CO 2 insufflation may be necessary [6]. The volume status of the neonate must be monitored closely because decreased venous return can be exaggerated in a mildly hypovolemic patient with increased intrathoracic pressure.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Low Tidal Volume and ETCO2 during Thoracoscopy in the Treatment of Tracheo-Esophageal Fistula: A Case Report

Zhao¹,

Chen²

2017

Ann Clin Lab Res

View full text Add to dashboard Cite

Esophageal atresia with tracheo-oesophageal fistula (TEF) occurs in 1 in 2500-3000 live births. Management of airway and ventilation in TEF repair is challenging. Nowadays, advances in minimally invasive surgical techniques and neonatal intensive care for neonates have allowed endoscopically repair of TEF, which lends another level of complexity to airway management. Usually, a sudden increase in ETCO 2 should alert the anesthesiologist to possible surgical trauma and entrainment of thoracoscopic gas. However, low ETCO 2 emerging with low tidal volume can also alerts the anesthesiologist to possible surgical trauma. We had an uncommon situation, where a sudden low ETCO 2 emerged with low tidal volume when doing the complete anastomosis. After communicating with surgeons, they stopped and tried to find the possible causes. Finally, it appeared to be a surgical injury on the right lung. Continuous communication between the surgeon and the anesthesiologist is imperative when performing these operations.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management of Low Tidal Volume and ETCO2 during Thoracoscopy in the Treatment of Tracheo-Esophageal Fistula: A Case Report

Zhao¹,

Chen²

2017

Ann Clin Lab Res

View full text Add to dashboard Cite

show abstract

“…Bronchoscopic intervention provides a good choice to palliate symptoms and reconstruct the airway and esophagus instead of surgical intervention especially in the patients with critical status. Airway stenting via endoscopic techniques is by far the optimal clinical option (8,9). The patients we reported were the one with aplastic anemia who had a very low level of platelet (2×10 9 /L) which might easily cause bleeding by surgery.…”

Section: Discussionmentioning

confidence: 99%

Tracheoesophageal fistula induced by invasive pulmonary aspergillosis

Zhu

Qian

et al. 2016

Ann. Transl. Med.

View full text Add to dashboard Cite

Invasive pulmonary aspergillosis (IPA) is commonly seen in immunocompromised patients, and tracheoesophageal fistula (TEF) induced by IPA is rare and seldom reported. Management of these critically ill patients is challenging and often requires a multidisciplinary approach. The authors reported an adult suffering from aplastic anemia who developed TEF caused by IPA. The diagnosis was confirmed following bronchoscopy and histopathological examination. Antifungal and bronchoscopic intervention provided a cure without any recurrence as yet.

show abstract

“…Esophageal atresia (EA) is the most common congenital anomaly of the esophagus and causes interrupted esophageal continuity and usually results in a tracheoesophageal fistula (TEF) (1). EA repair is a complex operation, even in full-term neonates (2), and has a negative impact on blood circulation and respiration, causing extra perioperative stress (3,4). In the case of patients with very low birth weight (VLBW), the operation is aggravated by several other factors.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)

Ritz

Widenmann-Grolig²,

Jechalke³

et al. 2020

Front. Pediatr.

View full text Add to dashboard Cite

Introduction: Primary repair of esophageal atresia (EA) in infants with very low birth weight (VLBW) and extremely low birth weight (ELBW) has been widely performed in pediatric surgery. However, several studies have shown that complication rates in infants with VLBW are high. We hypothesize preterm children benefit from a shorter, less-traumatizing operation in the first days of life, as staged repair implies. Methods: Patients with EA and VLBW were retrieved from the database of a large national patient organization KEKS e.V. Structured questionnaires were sent to all the patients' families; the responses were pseudonymized and sent to our institution. Results: Forty-eight questionnaires from patients were analyzed. The mean birth weight was 1,223 g (720–1,500 g). Primary repair was performed in 25 patients (52%). Anastomotic insufficiency (AI) was reported in 9 patients (19%), recurrent fistula (RF) in 8 (17%), and anastomotic stenosis in 24 patients (50%). Although AI was almost twice as common after primary repair than after staged repair (24 vs. 13%; p = 0.5), the difference was not statistically significant. RF was more frequent after primary repair (28 vs. 4%; p = 0.04), gastroesophageal reflux was more frequent in the group after staged repair (78 vs. 52%; p = 0.04), and both correlations were statistically significant. Intracranial hemorrhage (ICH) was reported in 11 patients (23%) and was observed in 7 of them (64%, p = 0.4) after primary repair. ICH was reported in 60% of patients with ELBW and 75% of patients when ELBW was paired with primary repair. Conclusion: This study demonstrates the complication rate in patients with VLBW is higher than the average of that in patients with EA. The study indicates that a staged approach may be an option in this specific patient group, as less RF and AI are seen after staged repair. ICH rate in patients with ELBW seemed to be especially lower after staged repair. Interestingly, gastroesophageal reflux was statistically significantly higher in the group after staged repair, and postoperative ventilation time was longer. It is therefore necessary to individually consider which surgical approach is appropriate for this special patient group.

show abstract

Airway and Ventilatory Management Options in Congenital Tracheoesophageal Fistula Repair

Cited by 25 publications

References 35 publications

Management of Low Tidal Volume and ETCO2 during Thoracoscopy in the Treatment of Tracheo-Esophageal Fistula: A Case Report

Management of Low Tidal Volume and ETCO2 during Thoracoscopy in the Treatment of Tracheo-Esophageal Fistula: A Case Report

Tracheoesophageal fistula induced by invasive pulmonary aspergillosis

Outcome of Patients With Esophageal Atresia and Very Low Birth Weight (≤ 1,500 g)

Contact Info

Product

Resources

About