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.