Repeated endotracheal intubations and bronchial lavage in the postoperative treatment of tracheoesophageal fistula.

Recurrent pulmonary atelectasis occurs often in neonates following primary repair of esophageal atresia, leading to massive pneumonia and respiratory failure. The atelectasis is caused by tenacious mucous plugs which are presumably formed as a result of ciliary mucosal damage secondary to reflux of gastric fluid through a tracheo-esophageal fistula. Early aggressive treatment of the atelectasis by repeated gentle tracheal intubation with bronchial lavage and suction is advocated. This treatment is well tolerated and is preferred to continuous intubation with its inherent dangers for the neonatal patient.