Sunday, July 15, 2007

From Research to the Real World

As I mentioned in my previous post, my research topic is on esophageal atresia (EA) with or without tracheoesophageal fistula (TEF). The disease is a congenital underdevelopment of the esophagus and trachea. These two tubes, for the most part, can be connected to each other, making eating and breathing almost impossible for the patient. The disease is not rare among newborns and has a prevalence of about 1 in 4000. For the past few weeks, I have just been reading up and doing statistical analysis on past cases on EA/TEF. To my surprise there happened to be a patient born and admitted in the neonatal intensive care unit (NICU) a few weeks ago with EA/TEF. I took the time to check out the patient and the patient history as my research and the real world were finally integrated.

The patient was born with the most common type EA/TEF. Her upper esophagus discontinued into a pouch and her bottom esophagus connected to her trachea (which would be the fistula part). As of recent decades, this repair would be an easy fix with a low mortality rate. Normally, the patient would be operated on within the first 48 hours, which is known as primary repair. However, this patient, and like 30% of all EA/TEF patients, has some type of other complication. In this case it was cardiac problems. The patient had to be admitted into surgery to fix her heart problem before fixing the EA/TEF. She would not be able to survive the EA/TEF recovery without everything else being healthy.

I wasn’t there for her heart operation, but found out that when the doctors closed the patients chest back up, the heart was beating against the chest wall causing too much pressure. The doctors, then had to re-open the chest and leave it open for a few days until she stabilized from heart sugery. They used some type of plastic see-thru-wrap (much like cling-wrap) to close up the chest cavity from the outside environment. This allowed the heart to beat freely. She remained in the NICU until her body stabilized; upon stabilization she returned to the operating room to have her chest closed. She will be back to the operating room in a few days (weeks?) to have her esophagus disconnected from her trachea and to connect the two disconnected esophagus’. They are waiting for her to stabilize before performing this operation.

In retrospect, the complications the patient had with her EA/TEF would have led to a low survival rate only 10-20 some years ago. Over the past decade the overall mortality for EA/TEF have gone down to 11% from 22%. This is due to refinements in NICU care, anesthetic management, ventilator support, and improved surgical techniques. The corrective surgery for EA/TEF is at a 96-98% success rate presently, but was at a 0% survival rate just 50 years ago.

As researchers especially in academic research, we do a lot of basic science –discovering this, studying about that. A lot of our research won’t make a difference in the real world until decades from now. This other realm of research I’ve been exposed to has some gratifying feelings, that being once you’re done with your research, it will have a direct impact on people and their lives.

No comments: