POST OPERATIVE NON-INVASIVE VENTILATION AND COMPLICATIONS IN OESOPHAGEAL ATRESIA-TRACHEOESOPHAGEAL FISTULA
Bibliographic record
Abstract
BACKGROUND: Advancements in critical care have been instrumental in the observed improvement in survival and complication rates in Oesophageal atresia-Tracheo-Oesophageal Fistula (OA-TOF). Nearly all neonates with OA-TOF undergo assisted ventilation at some point in the course of their post operative care. Post operative assisted ventilation strategies are heterogenous from one center to another and to date limited data are available to guide current practices of assisted ventilation in cases of OA-TOF. OBJECTIVES: The present study aims to examine the impact of post operative assisted ventilation strategies on clinically relevant outcomes in a retrospective series of OA-TOF patients. DESIGN/METHODS: A single center retrospective chart review was conducted including all neonates born with OA-TOF 1986-2016 for whom complete ventilatory data were available. Exclusion criteria: death prior to surgical repair, presence of pulmonary disease, cardiac malformation resulting in severe pulmonary hypertension. Primary data points evaluated were: Post-operative ventilation strategy, Survival, Anastomotic Leakage, Stricture, Pneumothorax and Mediastinitis. Statistical significance was determined using Chi-square test for p less than 0.05. RESULTS: 70 patient charts were reviewed. Assisted ventilation was used in 69 infants.1 infant was extubated from the operating room. 3 (4.3%) infants required HFOV postoperatively, 69 (98.5%) infants required conventional ventilation postoperatively and 19 (27.1%) were bridged with postextubation non-invasive ventilation (Continuous Positive Airway Pressure (CPAP), Non-invasive Positive Pressure Ventilation (NIPPV) or High-Flow Nasal Cannula (HFNC)). Survival was 68 (97.1%), incidence of stricture was 25 (35.7%), anastomotic leak 14 (20%), pneumothorax 9 (12.9%) and mediastinitis 4 (5.7%). 11 (15%) infants were on CPAP post-operatively. CPAP was statistically associated to stricture and death. 2 (2.9%) infants were on NIPPV post-operatively. NIPPV statistically associated to death. 6 (8.5%) infants were on HFNC post-operatively. HFNC was statistically associated to anastomotic leak. 10 (14.3%) infants had long gap OA-TOF. Long gap was statistically associated to leak, stricture, mediatinitis, pneumothorax and pneumonia. 8 (11.4) infants were reintubated. Reintubation was statistically associated to pneumothorax, mediastinitis and death. CONCLUSION: The most important finding of the present study is that CPAP assisted ventilation is associated with a significantly higher rate of oesophageal stricture and HFNC assisted ventilation is associated with a significantly higher rate of anastomotic leakage following repair of OA-TOF. We hope to use these findings to develop guidelines for ventilation strategies in the care of babies born with OA-TOF.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".