Document Detail

Management of esophageal atresia and tracheoesophageal fistula in the neonate with severe respiratory distress syndrome.
MedLine Citation:
PMID:  3900328     Owner:  NLM     Status:  MEDLINE    
In a 10-year period, 22 neonates with esophageal atresia (EA) and tracheoesophageal fistula (TEF) required high pressure ventilatory support soon after birth because of respiratory distress syndrome (RDS). Eleven of the 22 or 50% survived overall, but if the 5 patients who died before definitive surgical repair could be attempted are excluded, 11 of 17 or 65% survived. More importantly, 4 of 7 (57%) patients who had gastrostomy performed first survived while 7 of 10 (70%) who had fistula ligation performed first survived. The difficulties with intraoperative management of those who had gastrostomy performed first were even more impressive. Our experience leads us to conclude that patients with EA and TEF with severe RDS who require high pressure ventilation preoperatively represent a group of patients who require special consideration. The danger to such patients with increased pulmonary resistance is not gastric distention but sudden loss of intragastric pressure. In the presence of poor lung compliance, the upper gastrointestinal tract functions in continuity with the tracheobronchial tree. A sudden loss of intragastric pressure, as with placement of a gastrostomy tube, results in an acute loss of effective ventilating pressure. Resuscitation of such a patient is not possible until leakage from the esophagus is controlled by ligation of the fistula or transabdominal occlusion of the distal esophagus. Placement of a Fogarty catheter into the fistula via a bronchoscope is effective but may not be feasible in every case. Early thoracotomy and ligation of the fistula in patients with progressive RDS provides immediate improvement in ventilatory efficiency and relief of gastric distention.
J M Templeton; J J Templeton; L Schnaufer; H C Bishop; M M Ziegler; J A O'Neill
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  20     ISSN:  0022-3468     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  1985 Aug 
Date Detail:
Created Date:  1985-11-12     Completed Date:  1985-11-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  394-7     Citation Subset:  IM    
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MeSH Terms
Airway Resistance
Birth Weight
Esophageal Atresia / surgery,  therapy*
Infant, Newborn
Positive-Pressure Respiration
Respiratory Distress Syndrome, Newborn / etiology,  therapy*
Tracheoesophageal Fistula / surgery,  therapy*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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