التفاصيل البيبلوغرافية
| العنوان: |
Bronchoscopic Localization of Tracheoesophageal Fistula in Newborns with Esophageal Atresia: Intubate Above or Below the Fistula? |
| المؤلفون: |
Koo, Donna C., Scalise, P. Nina, Izadi, Shawn N., Kamran, Ali, Mohammed, Somala, Zendejas, Benjamin, Demehri, Farokh R. |
| المصدر: |
Journal of Pediatric Surgery; Mar2024, Vol. 59 Issue 3, p363-367, 5p |
| مستخلص: |
In neonates with suspected type C esophageal atresia and tracheoesophageal fistula (EA/TEF) who require preoperative intubation, some texts advocate for attempted "deep" or distal-to-fistula intubation. However, this can lead to gastric distension and ventilatory compromise if a distal fistula is accidently intubated. This study examines the distribution of tracheoesophageal fistula locations in neonates with type C EA/TEF as determined by intraoperative bronchoscopy. This was a single-center retrospective review of neonates with suspected type C EA/TEF who underwent primary repair with intraoperative bronchoscopy between 2010 and 2020. Data were collected on demographics and fistula location during bronchoscopic evaluation. Fistula location was categorized as amenable to blind deep intubation (>1.5 cm above carina) or not amenable to blind deep intubation intubation (≤1.5 cm above carina or carinal). Sixty-nine neonates underwent primary repair of Type C EA/TEF with intraoperative bronchoscopy during the study period. Three patients did not have documented fistula locations and were excluded (n = 66). In total, 49 (74 %) of patients were found to have fistulas located ≤1.5 cm from the carina that were not amenable to blind deep intubation. Only 17 patients (26 %) had fistulas >1.5 cm above carina potentially amenable to blind deep intubation. Most neonates with suspected type C esophageal atresia and tracheoesophageal fistula have distal tracheal and carinal fistulas that are not amenable to blind deep intubation. Level III. • Reported incidence of carinal TEF is inconsistent, ranging from 9 to 55 %. We examine the distribution of TEF in neonates with type C EA/TEF as determined by intraoperative bronchoscopy. • Most neonates with type C EA/TEF have distal tracheal and carinal fistulas that are not amenable to blind deep or beyond the fistula type intubation. • If the patient's tracheal anatomy is unknown at time of intubation, it is safer to place the ETT shallowly to avoid accidental fistula intubation rather than attempt to place the ETT blindly past the fistula. Once stabilized, flexible bronchoscopy via the ETT can confirm adequate ETT position. Importantly, expeditious plans to surgically address the TEF in the operating room should be made. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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