Airway Evaluation Prior to Closure of Tracheo-Cutaneous Fistula

The patient is a five year old, ex 23 week preemie whom was successfully decannulated with the tracheotomy removed in the ICU eleven months prior. The child did not have any airway reconstruction. As the techniques around decannulation as well as closure of trachea-cuteanous fistula are varied and at times controversial, it would be most excellent to see video sequences of the various ways to decannulate. The patient underwent a direct laryngoscopy and bronchoscopy and closure of the tracheo-cutaenous fistula. He is brought to the operating room for closure of a tracheo-cutaneous fistula. Prior to closure of the fistula, the patient had an airway evaluation to ensure that the airway was safe. Note the distal secretions and otherwise normal airway evaluation. The method for the airway evaluation in the setting of a trachea-cutaenous fistula is to first ensure the patient has adequate ventilation and oxygenation. If necessary and a very large fistula, the fistula may need to be covered with gauze or a finger to allow gas exchange. The airway evaluation then proceeds with a laryngoscope to expose the larynx and an endoscopic camera via a bronchoscope is passed through the vocal folds to evaluate the airway. This video demonstrates that there is no mucosal opening where the trachea-cutaneous fistula would be expected to be found.

DOI: http://dx.doi.org/10.17797/k7e0zijclp