Non-Operative Treatment for Tracheoesophageal Fistulae in Intensive Care Unit: Our Experience

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DM Palma AN Cracchiolo D Librizzi A La Sala L Serafino Agrusa

Abstract

Introduction: The aim of our retrospective analysis is to evaluate the results of conservative management of acquired tracheoesophageal fistulae (TEF). TEF are rare but potentially life-threatening emergencies which can be of either spontaneous or iatrogenic origin. Spontaneous ones can be congenital or secondary to malignancy. For acquired ones numerous causes have been documented, the most common of which are endotracheal and tracheostomy tube-related injuries.


Methods: From February 2016 to March 2019 seven patients (5 men; 2 women) with acquired TEF were diagnosed in our intensive care unit (ICU). The injury occurred after dilational percutaneous tracheostomy in three patients, after esophageal endoscopy in one patient, after cuff-related ruptures in three intubated and mechanically ventilated patients. Our patients had no particular medical history. Mean age: 46 years. Mean duration of signs before diagnosis: 8 hours. The median length of the injury was 1,4 cm. The mean duration of hospitalization in the ICU was 31 days.


Results: All patients underwent conservative management: antibiotic therapy, close brochoscopic controls, percutaneous endoscopic gastrostomy and tomographic investigation. No mediastinitis was observed. Two patients died from causes unrelated to the tracheal injury.


Conclusions: Successful management of acquired TEF requires a fast and straightforward diagnostic evaluation. According to our experience, conservative management of TEF may be a save option in patients with uncomplicated ventilation and moderate and nonprogressive emphysema.


 

Article Details

How to Cite
PALMA, DM et al. Non-Operative Treatment for Tracheoesophageal Fistulae in Intensive Care Unit: Our Experience. Medical Research Archives, [S.l.], v. 9, n. 3, mar. 2021. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2367>. Date accessed: 11 apr. 2021. doi: https://doi.org/10.18103/mra.v9i3.2367.
Section
Research Articles

References

1. Rajan S. Management of Acquired Benign Tracheoesophageal Fistulae. Thora Surg Clin. 2018 Aug; 28, 3: 385-392

2. Palade E, Passlick B. Surgery of traumatic tracheal and tracheobronchial injuries. Chirurg. 2011; 82:141-7

3. Grewal HS, Dangayach NS. Treatment of tracheobronchial injuries: A contemporary review. Chest 2019,155, 595–604

4. Trottier SJ, Hazard PB. Posterior tracheal wall perforation during percutaneous dilatational tracheostomy. Chest 1999; 115:1383-1389

5. Cardillo G, Carbone L, Carleo F. Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non surgical treatment. EurJCardiothoracSurg.2010; 37(3): 581-587

6. Wright FW. Radiology of the chest and related conditions 2002.P.11-6

7. Lopez Espadas F, Zabalo M. Bronchial rupture in blunt thoracic trauma. Arch Broncopneumol 2000; 36: 651–654

8. Gabor S, Renner H. Indications for surgery in tracheobronchial ruptures. Eur J Cardiothorac Surg 2001; 20: 399–404

9. Brosario P, Ardissone F. Post-intubation tracheal rupture. A case report on ten cases. Eur J Cardiothorac Surg 1997; 12: 98–100

10. Chen JD, Shanmuganathan K. Using CT to Diagnose Tracheal Rupture. AJR.2001; 176: 1273–1280


11. Qureshi YA, Muntzer Mughal M. Acquired Adult Aerodigestive Fistula: Classification and Management J Gastrointest Surg. 2018; 22(10): 1785–1794

12. Herrmann D, Volmerig J. Does less surgical trauma result in better outcome in management of iatrogenic tracheobronchial laceration? J.Thorac.Dis. 2019, 11, 4772–4781

13. Carretta A, Melloni G. Conservative and surgical treatment of acute posttraumatic tracheobronchial injuries. WorldJ.Surg. 2011, 35, 2568–2574

14. Marty-Ane CH, Picard E. Membranous tracheal rupture after endotracheal intubation. Ann Thorac Surg. 1995; 60:1367-1371

15. Miñambres E, Burón, J. Tracheal rupture after endotracheal intubation: A literature systematic review. Eur. J. Cardiothorac Surg.2009, 35, 1056–1062

16. Cui Y, Wang X. A case of tracheal tube rupture of an adult patient. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28: 426-7

17. Brinas P, Bréhin C. Conservative management of tracheal injuries in children: Clinical case and literature review. Arch Pediatr 2016; 23: 1067-70

18. Dienemann H, Hoffmann H. Tracheobronchial injuries and fistulas. Chirung 2001; 72:1130–1136


19. Tsunezuka Y, Sato H. Spontaneous tracheal rupture associatedwith acquired tracheobronchomalacia, Ann Thorac Cardiovasc Surg 2003; 9: 394-396

20. Carbognani P, Bobbio A. Management of postintubation membranous tracheal rupture. Ann Thorac Surg 2004; 77: 406–409

21. Brendan PM. Evolutional trends in the management of tracheal and bronchial injuries J Thorac Dis 2017 Jan; 9(1): E67–E70

22. Gomez-Caro AA, Moradiellos Diez FJ. Successful conservative management in iatrogenic tracheobronchial injury. Ann Thorac Surg 2005; 79:1872–8


23. Self ML, Mangram A. Nonoperative management of severe tracheobronchial injuries with positive end-expiratory pressure and low tidal volume ventilation J Trauma 2005; 59:1072–5


24. Lee SK, Kim DH. Does Surgical Repair Still have a Role for Iatrogenic Tracheobronchial Rupture? Clinical Analysis of a Thoracic Surgeon’s Opinion. Ann. Thorac. Cardiovasc. Surg. 2016, 22, 348–353

25. Athanassios K, Dimitrios M. Bronchoscopical Repair of Tracheal Laceration Using Conventional Instrumentation-A Novel Technique. AnnThoracSurg 2020, 109, 141–143

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