Acute and Critical Care

Occurrence of Acquired Tracheoesophageal Fistula Due to Excess Endotracheal Tube Cuff Volumes: A Case Report: Myeong Soo Kim, Eun Jeong Koh, Ha Young Choi; Korean J Crit Care Med. 2013;28(2):146-151.; DOI: https://doi.org/10.4266/kjccm.2013.28.2.146

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Endotracheal tube cuff volume and pressure require constant monitoring to prevent tracheal injury. Acquired tracheoesophageal fistula is common from complications of mechanical ventilation as a result of pressured necrosis of the tracheoesophageal wall by endotracheal tube cuff. It still represents a life-threatening condition, especially when the diagnosis is being delayed. We present our modest experience through an acquired TEF patient who had an excessively enlarged cuff diameter on chest radiogram in order to consider the potential of using radiological-measured cuff diameter as a simple technique for predicting tracheal damages. Although the cuff pressure was monitored with a manometer by the medical team, it was possible that the tube cuff was excessively enlarged. Proper procedures for preventing the tracheal damage by cuffs include the following: monitoring of endotracheal cuff pressure and volume, observation of cuff size on the chest radiogram, and being mindful and attentive for possibilities of misjudgements by manometer or medical teams.

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Korean Journal of Physical Anthropology.2017; 30(1): 7. CrossRef
Total Unilateral Obstruction by Sputum Immediately after Tracheal Bougienage
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Two Cases of Postintubation Tracheoesophageal Fistula in Patients with a History of Tracheostomy: Case Report: Seung Chan Kim, Kyung Won Ha, Joon Ho Wang, Se Jin Kim, Won Hak Kim, So Hee Jeong, Woo Sung Lee, Sang Don Han, Gyu Rak Chon; Korean J Crit Care Med. 2009;24(2):87-91.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.87

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Abstract PDF

Common causes of acquired tracheoesophageal (T-E) fistula are blunt trauma on the neck or chest, malignancy, long-term mechanical ventilation, and post-intubation injury. Most of the cases are fatal due to severe respiratory infection. We experienced two cases of post-intubation T-E fistula in patients with a history of tracheostomy that developed earlier than usual. One case was caused by excessive cuff pressure and the other by avulsion injury during endotracheal intubation. We can get instructions from these cases that how to prevent T-E fistula because it is hard to treat and causes severe outcomes.

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Occurrence of Acquired Tracheoesophageal Fistula Due to Excess Endotracheal Tube Cuff Volumes - A Case Report -
Myeong Soo Kim, Eun Jeong Koh, Ha Young Choi
Korean Journal of Critical Care Medicine.2013; 28(2): 146. CrossRef
Acquired Tracheoesophageal Fistula through Esophageal Diverticulum in Patient Who Had a Prolonged Tracheostomy Tube - A Case Report -
Jae Hwan Jung, Ji Sung Kim, Yong Kyun Kim
Annals of Rehabilitation Medicine.2011; 35(3): 436. CrossRef

Tracheoesophageal Fistula as a Complication after Endotracheal Intubation: A Case Report: Woong Mo Kim, Seong Wook Jeong, Sang Hyun Kwak, Sung Su Chung, Chang Young Jeong; Korean J Crit Care Med. 2003;18(1):39-42.

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Abstract PDF: Placement of endotracheal tube, even for extremely short periods, can result in injury to laryngeal and tracheal tissue. This may be clinically insignificant, but in rare cases, it could be life threatening and results in permanent disability. Especially, tracheoesophageal fistula (TEF) is a serious and challenging problem because it may contaminate the tracheobronchial tree and interfere with nutrition. This uncommon but lethal complication has been reported to be associated with certain risk factors in tracheally intubated patients, and better knowledge of these factors could reduce the incidence of post-intubation TEF. We report a case of 49-year old male patient who has acquired TEF caused by endotracheal intubation and positive pressure ventilation.

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