Postoperative noninvasive ventilation and complications in esophageal atresia–tracheoesophageal fistula
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In brief
In brief
Retrospective study of 91 EA-TEF patients found that postoperative noninvasive ventilation (NIPPV and HFNC) was associated with significantly increased risk of anastomotic leak and mediastinitis. Findings suggest caution with postextubation respiratory support strategies in this population and highlight need for prospective research.
Written by the GCMD Library team from the article.
Purpose
This study examines the impact of postoperative noninvasive ventilation strategies on outcomes in esophageal atresia–tracheoesophageal fistula (EA-TEF) patients.
Methods
A single center retrospective chart review was conducted on all neonates followed at the EA-TEF Clinic from 2005 to 2017. Primary outcomes were: survival, anastomotic leak, stricture, pneumothorax, and mediastinitis. Statistical significance was determined using Chi-square and logistic regression (p ≤ .05).
Results
We reviewed 91 charts. Twenty-five infants (27.5%) were bridged with postextubation noninvasive ventilation (15 on Continuous Positive Airway Pressure (CPAP), 5 on Noninvasive Positive Pressure Ventilation (NIPPV), and 14 on High-Flow Nasal Cannula (HFNC)). Overall, 88 (96.7%) patients survived, 25 (35.7%) had a stricture, 14 (20%) had anastomotic leak, 9 (12.9%) had a pneumothorax, and 4 (5.7%) had mediastinitis. Use of NIPPV was associated with increased risk of mediastinitis (P = .005). Use of HFNC was associated with anastomotic leak (P = .009) and mediastinitis (P = .036).
Conclusions
These data suggest that postoperative noninvasive ventilation techniques are associated with a significantly higher risk of anastomotic leak and mediastinitis. Further prospective research is needed to guide postoperative ventilation strategies in this population.
Type of study
Retrospective study.
Level of evidence
IV.