RESUMO
PURPOSE: To describe our experience using transthoracic ventilation to facilitate oral endotracheal tube (ETT) exchange after accidental ETT cuff rupture during a case of congenital tracheoesophageal fistula (TEF) repair. CLINICAL FEATURES: A 53-yr-old male underwent a congenital H-type TEF repair via right-sided thoracotomy with a single-lumen ETT and a bronchial blocker. A large air leak developed after ETT cuff rupture during fistula closure. Transthoracic intubation via tracheotomy was performed to continue ventilation during an oral ETT exchange in the lateral position. No hypoxia or hemodynamic compromise occurred. CONCLUSIONS: Airway device choice for TEF repair must be carefully considered in conjunction with the surgical team. In the present case of accidental ETT cuff rupture, rescue transthoracic ventilation safely facilitated oral ETT exchange.
RéSUMé: OBJECTIF: Décrire notre expérience avec la ventilation transthoracique pour faciliter l'échange de sonde endotrachéale (SET) orale après la rupture accidentelle du ballonnet de la SET lors d'un cas de réparation d'une fistule trachéo-oesophagienne (FTO) congénitale. CARACTéRISTIQUES CLINIQUES: Un homme de 53 ans a bénéficié d'une réparation de FTO congénitale de type H via une thoracotomie du côté droit avec une SET à simple lumière et un bloqueur bronchique. Une importante fuite d'air est apparue après la rupture du ballonnet de la SET lors de la fermeture de la fistule. Une intubation transthoracique par trachéotomie a été réalisée pour poursuivre la ventilation pendant un échange de SET orale en position latérale. Aucune hypoxie ou trouble hémodynamique ne s'est produit. CONCLUSION: Le choix du dispositif pour voies aériennes pour une réparation de FTO doit être soigneusement examiné en collaboration avec l'équipe chirurgicale. Dans le cas présent d'une rupture accidentelle du ballonnet de la SET, la ventilation transthoracique de secours a facilité un échange de SET orale en toute sécurité.
Assuntos
Fístula Traqueoesofágica , Adulto , Humanos , Intubação Intratraqueal/efeitos adversos , Masculino , Respiração , Toracotomia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/cirurgia , Traqueostomia/efeitos adversosRESUMO
BACKGROUND: Bilateral Wilms tumor (BWT) is a rare entity. The goal of this study is to report outcomes (overall and event-free survival, OS/EFS) of BWT in a large cohort representative of the Canadian population since 2000. We focused on the occurrence of late events (relapse or death beyond 18 months), as well as outcomes of patients treated following the only protocol specifically designed for BWT to date, AREN0534, compared to patients treated following other therapeutic schemes. METHODS: Data was obtained for patients diagnosed with BWT between 2001 and 2018 from the Cancer in Young People in Canada (CYP-C) database. Demographics, treatment protocols, and dates for events were collected. Specifically, we examined outcomes of patients treated according to the Children's Oncology Group (COG) protocol AREN0534 since 2009. Survival analysis was performed. RESULTS: 57/816 (7%) of patients with Wilms tumor had BWT during the study period. Median age at diagnosis was 2.74 years (IQR 1.37-4.48) and 35 (64%) were female; 8/57 (15%) had metastatic disease. After a median follow-up of 4.8 years (IQR 2.8-5.7 years, range 0.2-18 years), OS and EFS were 86% (CI 73-93%) and 80% (CI 66-89%), respectively. Less than 5 events were recorded after 18 months from diagnosis. Since 2009, patients treated according to the AREN0534 protocol had a statistically significant higher OS compared to patients treated with other protocols. CONCLUSIONS: In this large Canadian cohort of patients with BWT, OS and EFS compared favorably to the published literature. Late events were rare. Patients treated according to a disease-specific protocol (AREN0534) had improved overall survival. TYPE OF STUDY: Original article. LEVEL OF EVIDENCE: Level IV.