The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

OVERINFLATION CUFF OF TRACHESTOMY TUBE-ACQUIRED POST INTUBATION TRACHEO-ESOPHAGEAL FISTULA

Shao Yu Li, Jen-Yu Hung, Jong Rung Tsai; Kaohsiung Medical University, Kaohsiung, Taiwan

Introduction: An acquired tracheo-esophageal (T-E) fistula is an abnormal communication between the trachea and esophagus. It is an infrequent complication with a variety of conditions, occurring most commonly in relation to tumors, prolonged mechanical ventilation, mediastinal inflammation and trauma. Case summary: A 90-year-old female patient was a victim of chronic respiratory failure with mechanical ventilator support. The patient had fever and shortness of breath, and her condition deteriorated in the period of one week. Additionally, she had frequent cough attacks - especially after nasogastric tube feeding. As her oxygenation and shortness of breath deteriorated, she was transferred to our hospital. At our emergency room, a chest X-ray revealed overinflation tracheostomy tube cuff and a prominence of gastric gas except bilateral lower lobe pneumonia and reticulonodular pattern. High cuff pressure was noted by sphygmomanometer. As we tried to release the cuff pressure, significant air drainage from the nasogastric tube was found. Low inhalation tidal volume was also noted. Tracheo-esophageal fistula was then highly suspected. Immediate bronchoscope examination revealed a large tracheo-esophageal fistula at the cuff area after deflation the cuff. We replaced the tracheostomy tube with a longer vertical tracheostomy tube to bypass the T-E fistula. With a consistent antibiotic and nutrition supply, her clinical condition became stable. However, the patient’s family refused subsequent surgical intervention and the patient was transferred back to the respiratory care ward later. Discussion: Cuffed endotracheal and tracheostomy tube can seal the tracheal lumen by inflating the cuff to maintain airway pressure and prevent aspiration of regurgitation. The cuff pressure exerted against the mucosa by inflated cuff can impair mucosal blood flow and induce several tracheal complications, including loss of mucosal cilia, ulceration, hemorrhage, tracheal stenosis and T-E fistula. Now, it is recommended cuff pressure should be frequent monitor and be maintained at 20–25 mmHg (25–35 cmH2O) to minimize the risks for both tracheal-wall injury and aspiration. Sponsored Research - None