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Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group
  • +7
  • Anastassios Koumbourlis,
  • Yvonne Belessis,
  • Mary Cataletto,
  • Renato Cutrera,
  • Emily DeBoer,
  • Mikhail Kazachkov,
  • Sophie Laberge,
  • Jonathan Popler,
  • Federica Porcaro,
  • Tom Kovesi
Anastassios Koumbourlis
Children's National Medical Center
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Yvonne Belessis
Sydney Children's Hospital Randwick
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Mary Cataletto
New York University Medical Center
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Renato Cutrera
Bambino Gesù Childrens’ Hospital, IRCCS
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Emily DeBoer
University of Colorado Anschutz Medical Campus
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Mikhail Kazachkov
NYU Langone Medical Center
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Sophie Laberge
CHU Sainte-Justine
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Jonathan Popler
Children's Physician Group Pulmonology
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Federica Porcaro
Bambino Gesù Children's Hospital
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Tom Kovesi
CHEO,Ottawa
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Abstract

Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, C based on whether they were based on “strong”, “moderate” or “weak” agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Non-invasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients’ age were also developed.

Peer review status:ACCEPTED

04 Jun 2020Submitted to Pediatric Pulmonology
05 Jun 2020Submission Checks Completed
05 Jun 2020Assigned to Editor
08 Jun 2020Reviewer(s) Assigned
07 Jul 2020Review(s) Completed, Editorial Evaluation Pending
18 Jul 20201st Revision Received
21 Jul 2020Submission Checks Completed
21 Jul 2020Assigned to Editor
21 Jul 2020Reviewer(s) Assigned
22 Jul 2020Review(s) Completed, Editorial Evaluation Pending
23 Jul 2020Editorial Decision: Accept