“…Cuffed pediatric tubes can effectively occlude TEF ostium, permitting bowel deflation, and better lung recruitment in ARDS-as in our experiencewhere a preset end-expiratory pressure maintenance can be life-saving. 13,14 Fistula occlusion with Fogarty arterial embolectomy catheter has been also described in cases of large TEF and decreased lung compliance. 15,16 However, cuffed tubes may result very dangerous in rTEF, as they can dramatically enlarge a previous fistula during blinded, careless placement 17,18 even if the possibility of initially missed upper fistula should always bear in mind; moreover, sometimes tracheal leak diameters and/or injury level do not allow complete occlusion, requiring operative occlusion procedures.…”