The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

TRACHEAL AGENESIS

Hsiang T. Chang, Zen-Kong Dai, Hsiung-I Tseng, Shah-Hwa Chou; Kaohsiung Medical University, Kaohsiung, Taiwan

Introduction: Tracheal agenesis is a rare congenital malformation of the respiratory tract where patients lack the fistule between the airway and esophagus. This condition is incompatible with life. There are classification by” Floyyd’s”. Our patient belongs to type II. The prognosis is not much different, it depends on airway achievement and maintain. Case Summary: A 32 day-old new born male was transferred to KMU. When he was born, there was no meconium stain; however, poor activity, cyanosis, and delay of initial crying were noted. Ambulatory bagging was given, an endotracheal tube was inserted, and chest compression was performed due to bradycardia (<60). Under these circumstances, the infant was transferred to the NICU for further evaluation and management. In the NICU, we did a more detailed physical examination, and found that the infant had subcostal retraction. More importantly, the breathing sound of the infant had bilateral crackles. As for blood examination, we could see that the WBC had increased slightly, and that PCO2,CPK,CK-MB had raised substantially. Treatments included not only general survey, but also antibiotics such as Ampictin/Gentamicin or ETT with ventilator support. In the end, we used NG insertion. With a bronchoscope, we found that the tracheal atresia with T-E fistula was impressed; therefore, NPO with TPN. We confirmed the tracheal agenesis by HRCT because the fibrotic bronchoscope showed a normal, larynx but the subglottic area was difficult to assess. Conclusion: Although emergency management (by either bag and mask ventilation or esophageal intubation) can at times be successful after definitive diagnosis of tracheal agenesis, long-term therapy of this condition remains a problem. We feel that at present, with no long-term solutions for tracheal agenesis at hand, it would be appropriate to consider minimizing clinical interventions once the diagnosis has been made. Sponsored Research - None