Tracheoesophageal Fistula
Background
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May be diagnosed antenatally on prenatal U/S
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Presents as excessive oral secretions, with coughing & cyanosis during feeds
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Unable to pass NG into stomach
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Usually repaired w/in 24 hours of birth to minimize risk and complications of aspiration
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Types: I-III (see picture below)
Considerations
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Aspiration risk
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Risk of dehydration/acidosis
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GI distension can compromise ventilation
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May require urgent gastrostomy decompression
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Intraop surgical retraction can compress airways, major vessels, & heart
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Associated conditions
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VACTERL
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Cardiac anomalies: preop echo required
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Prematurity
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Management
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Decompress blind upper pouch with NG to suction
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Raise head to reduce risk of aspiration
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Advance ETT into right mainstem; slowly withdraw until bilateral breath sounds heard
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Goal: tip of ETT between carina & fistula
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Spontaneous ventilation is preferred
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Low airway pressures if PPV required
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Avoid N2O (gastric distension)
