Tracheomegaly and tracheosephagial fistula following mechanical ventilation: A case report and review of the literature

Kucuk, Canan; Arda, Kemal; Ata, Naim; Türkkanı, Mustafa Hamidullah; Yildiz, Ozgur Omer

doi:10.1016/j.rmcr.2016.02.003

Cited by 7 publications

(15 citation statements)

References 16 publications

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“…4,7,9 Prolonged ventilation induced TEF usually develops after 15-200 days. In our case, intubation duration was 11 days which was shorter than reported in the literature; 5,10 however, multiple intubations due to tube blockade, restlessness, and use of steroid for suspected meningococcal/tubercular meningitis might be the predisposing factors for TEF early in our case. Copious productive cough intermittently and coughing after each food intake were the clinical presentations as in the literature.…”

Section: Discussionmentioning

confidence: 42%

“…This was a good learning experience for us working daily in intensive care unit; furthermore, by selecting appropriate endotracheal tube cuff size, pressure monitoring, and avoiding hypermobility of tube and patient,we can minimize the risk of intubationrelated complications like benign TEF. 4,5 We successfully highlighted TEF early prior to serious complications. Our study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis and surgical correction have a better prognosis. 1,4,5 We are reporting a rare case diagnosed early on esophagogastroscopy before the complication such as pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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Prolonged Intubation Induced Tracheoesophageal Fistula in Suspected Meningococcal Sepsis with ARDS: A Case Report

Rana¹,

Sapkota²,

Shakya³

et al. 2018

J Nepal Med Assoc

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Tracheoesophageal fistula is an abnormal communication between trachea and esophagus. Benign acquired types are rare with the incidence of less than 1%. Prolonged endotracheal intubation remains the most common cause. We are reporting a 28 years old female patient presented with chief complaint of a cough after each meal intake in the outpatient clinic. She had a recent history of admission in the intensive care unit with prolonged intubation (11 days). Her general physical examination, laboratory examination, and chest x-ray were normal. Esophagogastroscopy was performed and revealed communication between upper esophagus and trachea approximately at 14-17cm embedded in longitudinal mucosal folds of the esophagus. She was referred to the higher center for surgical repair. Though, a rare complication, high suspicion is necessary to accurately diagnose the disease in a patient with the history of prolonged intubation.

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

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Prolonged Intubation Induced Tracheoesophageal Fistula in Suspected Meningococcal Sepsis with ARDS: A Case Report

Rana¹,

Sapkota²,

Shakya³

et al. 2018

J Nepal Med Assoc

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“…Typically, tracheomegaly patients are males over age 40; this presentation becomes a bit more variable when looking at patients with the acquired version of this rare disorder. 6 On review of the literature, the classic presentation of chronic tracheomegaly includes persistent cough, 1 , 5 , 6 , 7 , 8 , 9 dyspnea, 5 , 6 , 7 , 8 , 10 chronic respiratory infections, 1 , 7 , 8 , 11 , 13 , 12 breathlessness, 6 bronchiectasis, 6 , 8 , 13 heavy secretions, 6 , 8 hemoptysis, 6 , 8 and weight loss. 9 Physical exam findings in chronic tracheomegaly patients can include rales, 6 , 7 finger clubbing, 6 , 7 bronchial breathing, 13 and hoarseness.…”

Section: Resultsmentioning

confidence: 99%

Acquired Tracheomegaly in Critically Ill Patients With COVID-19: A Literature Review

Collins¹

2022

The Journal for Nurse Practitioners

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“…Intra cuff pressures of > 50 cm of H2O can lead to complete occlusion of tracheal blood flow and in those with hypotension, pressures of 34 cm H 2 O can lead to tracheal damage ( 9 ). It is usually recommended that cuff pressures be less than 20 cm H 2 O and the cuff volume limited to 6 - 8 mL ( 10 ). However, the presence of airway edema as in angioedema may lead to an underestimation of the assessed cuff pressures.…”

Section: Discussionmentioning

confidence: 99%

Using Bronchoscopy to Detect Acquired Tracheoesophageal Fistula in Mechanically Ventilated Patients

et al. 2017

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IntroductionAn acquired Tracheoesophageal fistula (TEF) is commonly caused by a malignancy or trauma, with pulmonary infection or aspiration being the presenting symptom. However, in the critical care setting the presentation can be subtle and may present with difficult ventilation. High endotracheal tube cuff pressures can lead to tracheal erosions and thus increasing the chances for developing a TEF. Prolonged intubation in the presence of other risk factors like poor general state of health, episodic hypotension, nasogastric tubes, and repeated intubations can increase the likelihood of developing an acquired TEF. Angioedema of the airway is a rare but potentially devastating complication of angiotensin converting enzyme inhibitors (ACE-I) that could further add insult to the tracheal mucosa, predisposing to an acquired TEF.Case PresentationAn elderly woman with multiple comorbidities and requiring mechanical ventilation, developed angioedema following intake of ACE inhibitor for hypertension. The ensuing airway edema made weaning off mechanical ventilation difficult. After repeated attempts at extubation, tracheostomy was performed. With the loss of airway after tracheostomy, the possibility of TEF was considered given her multiple risk factors and intra-operative findings of the tracheal mucosa.ConclusionsWhile it may be difficult to predict who will actually develop a TEF, it is prudent to identify those at risk and take precautionary measures to prevent one. Emphasis should be placed on daily endotracheal cuff manometric pressure check to prevent ischemic changes of the tracheal mucosa resulting from high cuff pressures. Also, bronchoscopy could be used after extubating susceptible patients to detect an acquired TEF.

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Tracheomegaly and tracheosephagial fistula following mechanical ventilation: A case report and review of the literature

Cited by 7 publications

References 16 publications

Prolonged Intubation Induced Tracheoesophageal Fistula in Suspected Meningococcal Sepsis with ARDS: A Case Report

Prolonged Intubation Induced Tracheoesophageal Fistula in Suspected Meningococcal Sepsis with ARDS: A Case Report

Acquired Tracheomegaly in Critically Ill Patients With COVID-19: A Literature Review

Using Bronchoscopy to Detect Acquired Tracheoesophageal Fistula in Mechanically Ventilated Patients

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