Iatrogenic Complete Ventilatory Failure in Two Neonates Undergoing Tracheoesophageal Fistula Repair

Gupta, Anju; Gupta, Nishkarsh

doi:10.5152/tjar.2020.30771

Cited by 1 publication

(2 citation statements)

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“…9 Improper ventilation can cause gastric distension or even rupture, gastric reflux, or hypotension. 10 Hypoxemia can occur intraoperatively due to various reasons, such as surgeon's packing the lung to mobilize the distal esophageal end, misplacement of the ETT in the right main bronchus, blocking of ETT with secretions or blood, twisting of the bronchus or the trachea, and atelectasis. 1 The influence of lateral decubitus on ventilation/perfusion (V/Q ) mismatch is different in infants compared to adults.…”

Section: Discussionmentioning

confidence: 99%

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Inverse ratio ventilation versus conventional ratio ventilation during one lung ventilation in neonatal open repair of esophageal atresia/tracheoesophageal fistula: A randomized clinical trial

Youssef,

El‐Ozairy,

El‐Hennawy

et al. 2024

Pediatric Anesthesia

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BackgroundMaintaining oxygenation during neonatal open repair of esophageal atresia/tracheoesophageal fistula is difficult. Inverse ratio ventilation can be used during one lung ventilation to improve the oxygenation and lung mechanics.ObjectiveThe aim of this study was to describe the impact of two different ventilatory strategies (inverse ratio ventilation vs. conventional ratio ventilation) during one lung ventilation in neonatal open repair of esophageal atresia/tracheoesophageal fistula on the incidence of oxygen desaturation episodes.MethodsWe enrolled 40 term neonates undergoing open right thoracotomy for esophageal atresia/tracheoesophageal fistula repair and randomly assigned into two groups based on inspiratory to expiratory ratio of mechanical ventilation parameters (2:1 in inverse ratio ventilation “IRV” and 1:2 in conventional ratio ventilation “CRV”). The incidence of desaturation episodes that required stopping the procedure and reinflation of the lung were recorded as the primary outcome while hemodynamic parameters, incidence of complications, and length of surgical procedure were recorded as the secondary outcomes.ResultsThere was a trend toward a reduction in the incidence of severe desaturations (requiring stopping of surgery) with the use of inverse ratio ventilation (15% in IRV vs. 35% in CRV, RR [95% CI] 0.429 [0.129–1.426]). Incidence of all desaturations (including those requiring only an increase in ventilatory support or inspired oxygen saturation) was also reduced (40% in IRV vs. 75% in CRV, RR [95% CI] 0.533 [0.295–0.965]). This in turn affected the length of surgical procedure being significantly shorter in inverse ratio ventilation group (mean difference −16.3, 95% CI −31.64 to −0.958). The intraoperative fraction of inspired oxygen required to maintain adequate oxygen saturation was significantly lower in the inverse ratio ventilation group than in the conventional ratio ventilation group (mean difference −0.22, 95% CI −0.33 to −0.098), with no significant difference in hemodynamic stability or complications apart from higher blood loss in inverse ratio group.ConclusionThere may be a role for inverse ratio ventilation with appropriate positive end‐expiratory pressure to reduce the incidence of hypoxemia during open repair of esophageal atresia/tracheoesophageal fistula in neonates, further studies are required to establish the safety and efficacy of this technique.

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Section: Discussionmentioning

confidence: 99%

“…Some of these challenges are: misplacement of ETT in the fistula, gastric distension, severe preexisting lung disease mainly due to aspiration, respiratory disease of prematurity, and associated anomalies especially cardiac ones 9 . Improper ventilation can cause gastric distension or even rupture, gastric reflux, or hypotension 10 …”

Section: Discussionmentioning

confidence: 99%