Esophageal atresia and severe respiratory failure—cuffed pediatric tracheal tubes as an additional therapeutic option?

Tracheoscopy assisted repair of tracheo‐esophageal fistula (TARTEF): a 10‐year experience

“…This position is often impossible because of a very low or even mainstem position of the fistula and even if so, an oversized tube would be required to be effective. Reliable occlusion of the fistula has been reported using a cuffed tracheal tube (10,11) or a Fogarty catheter (3,19) and is relevant for the intensive care setting when high airway pressures may be required.…”

“…However, IPPV through the tracheal tube lying with its tip above the fistula may cause gastric hyperinflation and the fiberoptic bronchoscope (FOB) could hamper ventilation in these patients (10–12). The appropriateness of this sort of airway management is controversial (13), and no data about the feasibility and/or safety (13,14) of TARTEF in a large population of newborns with TEF are available.…”

Recurrent Tracheoesophageal Fistula and Respiratory Failure: The Role of Early Airway Endoscopic Approach

“…Cuffed pediatric tubes can effectively occlude TEF ostium, permitting bowel deflation, and better lung recruitment in ARDS-as in our experiencewhere a preset end-expiratory pressure maintenance can be life-saving. 13,14 Fistula occlusion with Fogarty arterial embolectomy catheter has been also described in cases of large TEF and decreased lung compliance. 15,16 However, cuffed tubes may result very dangerous in rTEF, as they can dramatically enlarge a previous fistula during blinded, careless placement 17,18 even if the possibility of initially missed upper fistula should always bear in mind; moreover, sometimes tracheal leak diameters and/or injury level do not allow complete occlusion, requiring operative occlusion procedures.…”