Introduction
Preoperative management of neonates with esophageal atresia and
tracheoesophageal fistula (EA/TEF) remains challenging and requires
multidisciplinary support including neonatologist, pulmonologist,
surgeon and anesthetist. EA/TEF may frequently complicate with
respiratory distress due to coexisted prematurity,1-3tracheomalacia (TM),4,5 gastric distension or
aspiration pneumonitis. However, respiratory support with positive
pressure ventilation (PPV) may be ineffective with large fistulas due to
ventilation shunting through the fistula. This shunting may lead severe
gastric distention that consequently restricts lung expansion, impaired
pulmonary function and overall clinical deterioration. The main goal of
preoperative management of EA/TEF is to stabilize the general status of
the patient so that definite surgical correction can be carried out
under best possible conditions. In the published literatures, the use
balloon of Fogarty catheter to occlude the fistula6 or
umbilical catheter through the fistula for gastric
decompression7 has been suggested to accomplish such
means.
“Pharyngeal oxygen with optional nose-close and abdomen-compression
(PhO2-NC-AC)” is a novel model of noninvasive
ventilation (NIV).8-10 Its clinical application and
operation are simple without using any artificial devices such as
Ambu-bag, face or nasal mask, laryngeal mask airway, endotracheal tube
(ETT), or mechanical ventilator. This approach has already been
demonstrated to provide adequate oxygenation and PPV during flexible
endoscopy (FE) interventions in pediatric patients, even those in severe
asphyxiated status. In this NIV, a prolonged duration of nose-close,
sustained pharyngeal inflation (SPI), can create positive pressure and
make expansion in the laryngopharyngeal space.11
Here, we present our experience in preoperative management of neonates
with EA/TEF and moderated respiratory distress where FE with this NIV
and SPI (FE-NIV-SPI) facilitated safe, accurate examination and
placement of naso-tracheo-fistula-gastric (NTFG) tube.