Tracheoesophageal Fistula 

 

 

Background 

 

  • May be diagnosed antenatally on prenatal U/S

  • Presents as excessive oral secretions, with coughing & cyanosis during feeds

  • Unable to pass NG into stomach

  • Usually repaired w/in 24 hours of birth to minimize risk and complications of aspiration

  • Types: I-III (see picture below) 

 

 

 

 

 

 

 

 

 

 

Considerations 

 

  • Aspiration risk

  • Risk of dehydration/acidosis

  • GI distension can compromise ventilation

  • May require urgent gastrostomy decompression

  • Intraop surgical retraction can compress airways, major vessels, & heart

  • Associated conditions

    • VACTERL

    • Cardiac anomalies: preop echo required

    • Prematurity

 

 

Management 

 

  • Decompress blind upper pouch with NG to suction

  • Raise head to reduce risk of aspiration

  • Advance ETT into right mainstem; slowly withdraw until bilateral breath sounds heard

  • Goal: tip of ETT between carina & fistula

  • Spontaneous ventilation is preferred

  • Low airway pressures if PPV required

  • Avoid N2O (gastric distension)

 

 

 

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