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2018, Number 4

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Revista Cubana de Cirugía 2018; 57 (4)

Care of the post-intubation tracheoesophageal fistulae

Fuentes VE

Language: Spanish
References: 29
Page: 93-108
PDF size: 391.93 Kb.


ABSTRACT

Introduction: Post-intubation tracheoesophageal fistulae are severe lesions with high frequency of complication and high rate of mortality.
Objective: To update the knowledge about the diagnosis and treatment of patients with this disease.
Method: Literature review made in PUBMEDF/Medline and Infomed using the keywords: fistula, traqueoesophageal, tracheoesophageal fistula, and post-intubation in Spanish and English. References of articles were also reviewed to find out relevant publications. Prospective papers were particularly chosen. The case reports were only taken into account when they made reference to some novel technique.
Results: In this search, 4260 articles were found in Medline/Pubmed and 17 in Infomed databases. No clinical assays, meta-analysis or systematic reviews were found. Most of the articles made reference to case reports and some to retrospective studies. The case reports were only used if they described a novel technique.
Conclusions: Prolonged endotracheal intubation is the main cause of traqueoesophageal fistula. The pathogeny is associated to ischemia secondary to compression of posterior tracheal wall and anterior esophageal wall between the inflated cuff of the endotracheal tube and the nasogastric probe. In general, the conservative treatment does not cure the fistula but may restrict contamination of the tracheobronchial tree and guarantee nutrition. The esophageal shunt is rarely indicated, except when the gastrointestinal content continues entering into the VR. At present, the definitive treatment is the esophageal suturing and in most of cases, the resection and tracheal anastomosis.


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