Failed weaning due to acquired tracheo-oesophageal fistula and tracheal stenosis: a case report

Tracheo-oesophageal fistula is defined as abnormal connection between the oesophagus and the trachea. It is a life-threatening emergency that warrants urgent attention and treatment as the patent tract bypasses the normal protection offered by laryngeal reflexes. Pulmonary complications such as aspiration pneumonia and pneumonitis can follow. Tracheostomy tube cuffs seal against the tracheal wall and prevent leakage of air around the tube, assuring that the tidal volume is delivered to the lungs. Measures to prevent tracheal stenosis include inflation of cuffs when necessary, maintenance of intracuff pressures less than 20 cmH 2 O using properly sized tracheostomy tubes, and avoidance of excessive pressure of the tube tip on either the anterior or the posterior tracheal wall. We report a case of acquired tracheo-oesophageal fistula and tracheal stenosis secondary to high pressure in the cuff of the tracheostomy tube. This situation can present the anaesthetists with significant difficulties.