A Fatal Complication in Intensive Care Units: Tracheoesophageal Fistula

Fatih Şahin; Havva Kocayigit

Article Details

A Fatal Complication in Intensive Care Units: Tracheoesophageal Fistula

Authors:

Fatih Şahin | Havva Kocayigit

Publisher:

Hitit University

Main Topics:

Anesteziyoloji

Journal:

Hitit Medical Journal Vol.7 Issue 2, pp.181-187

Document Type:

Article

Publication Date:

6/2025

Document Language:

English

Document ID (Org No.):

2001351596

pISSN:

2687-4717

Keywords:

Abstract:

 Objective: Tracheoesophageal fistula is an abnormal connection between the posterior wall of the trachea and the anterior wall of the adjacent esophagus. Its etiology includes trauma related to endotracheal cuff, damage to the posterior wall during tracheostomy procedure, poor health status, respiratory infections, and steroid treatments. This study aims to investigate the demographic characteristics of patients with tracheoesophageal fistula, the timing of tracheostomy, duration of intubation, and the characteristics of microorganisms isolated from these patients. Material and Method: The study included patients who developed tracheoesophageal fistula while receiving mechanical ventilation through orotracheal intubation or tracheostomy in the intensive care unit. Data collected included age, sex, reason for intensive care unit admission, day of tracheoesophageal fistula occurrence, tracheostomy status, mortality, medication usage, and microorganisms isolated from tracheal aspirate cultures. Results: Thirty patients were included. The mean duration of mechanical ventilation before tracheoesophageal fistula development was 41.3 days, with 27 patients 90 having tracheostomies. The average day of tracheostomy application was 21.7 days. The mean duration of mechanical ventilation was 68.5 days, and the average intensive care unit stay was 71.2 days. Of 65 deep tracheal aspirate cultures samples, 24 patients 80 exhibited growth, predominantly Klebsiella pneumoniae 26.1. Mortality occurred in 86.7 of patients, while 13.3 were discharged in healty. Conclusion: In conclusion, tracheoesophageal fistula, which can be observed in intensive care units, is a highly mortal complication. The majority of these patients exhibited prolonged mechanical ventilation, microorganism growth in tracheal aspirate cultures, steroid use, hypoalbuminemia, use of neuromuscular agents, and high SAPS III and APACHE II scores.

 Objective: Tracheoesophageal fistula is an abnormal connection between the posterior wall of the trachea and the anterior wall of the adjacent esophagus. Its etiology includes trauma related to endotracheal cuff, damage to the posterior wall during tracheostomy procedure, poor health status, respiratory infections, and steroid treatments. This study aims to investigate the demographic characteristics of patients with tracheoesophageal fistula, the timing of tracheostomy, duration of intubation, and the characteristics of microorganisms isolated from these patients. Material and Method: The study included patients who developed tracheoesophageal fistula while receiving mechanical ventilation through orotracheal intubation or tracheostomy in the intensive care unit. Data collected included age, sex, reason for intensive care unit admission, day of tracheoesophageal fistula occurrence, tracheostomy status, mortality, medication usage, and microorganisms isolated from tracheal aspirate cultures. Results: Thirty patients were included. The mean duration of mechanical ventilation before tracheoesophageal fistula development was 41.3 days, with 27 patients 90 having tracheostomies. The average day of tracheostomy application was 21.7 days. The mean duration of mechanical ventilation was 68.5 days, and the average intensive care unit stay was 71.2 days. Of 65 deep tracheal aspirate cultures samples, 24 patients 80 exhibited growth, predominantly Klebsiella pneumoniae 26.1. Mortality occurred in 86.7 of patients, while 13.3 were discharged in healty. Conclusion: In conclusion, tracheoesophageal fistula, which can be observed in intensive care units, is a highly mortal complication. The majority of these patients exhibited prolonged mechanical ventilation, microorganism growth in tracheal aspirate cultures, steroid use, hypoalbuminemia, use of neuromuscular agents, and high SAPS III and APACHE II scores.

 Objective: Tracheoesophageal fistula is an abnormal connection between the posterior wall of the trachea and the anterior wall of the adjacent esophagus. Its etiology includes trauma related to endotracheal cuff, damage to the posterior wall during tracheostomy procedure, poor health status, respiratory infections, and steroid treatments. This study aims to investigate the demographic characteristics of patients with tracheoesophageal fistula, the timing of tracheostomy, duration of intubation, and the characteristics of microorganisms isolated from these patients. Material and Method: The study included patients who developed tracheoesophageal fistula while receiving mechanical ventilation through orotracheal intubation or tracheostomy in the intensive care unit. Data collected included age, sex, reason for intensive care unit admission, day of tracheoesophageal fistula occurrence, tracheostomy status, mortality, medication usage, and microorganisms isolated from tracheal aspirate cultures. Results: Thirty patients were included. The mean duration of mechanical ventilation before tracheoesophageal fistula development was 41.3 days, with 27 patients 90 having tracheostomies. The average day of tracheostomy application was 21.7 days. The mean duration of mechanical ventilation was 68.5 days, and the average intensive care unit stay was 71.2 days. Of 65 deep tracheal aspirate cultures samples, 24 patients 80 exhibited growth, predominantly Klebsiella pneumoniae 26.1. Mortality occurred in 86.7 of patients, while 13.3 were discharged in healty. Conclusion: In conclusion, tracheoesophageal fistula, which can be observed in intensive care units, is a highly mortal complication. The majority of these patients exhibited prolonged mechanical ventilation, microorganism growth in tracheal aspirate cultures, steroid use, hypoalbuminemia, use of neuromuscular agents, and high SAPS III and APACHE II scores.

 Amaç: Trakea-özofageal fistül, trakeanın posterior duvarı ile komşu özofagusun anterior duvarı arasında gelişen anormal yoldur ve etiyolojisinde endotrakeal balon ilişkili travma, trakeostomi uygulaması sırasında arka duvar hasarı, kötü genel sağlık durumu, solunum yolu enfeksiyonları ve steroid tedavileri bildirilmiştir. Bizim bu çalışmadaki amacımız trakea-özofageal fistül gelişen hastaların demografik özelliklerini, trakeostomi uygulanma zamanını ve hastaların trakeal aspirasyon kültürlerinde üreyen mikroorganizmaların özelliklerini araştırmaktır. Gereç ve Yöntem: Çalışmaya herhangi bir sebeple yoğun bakım ünitesinde orotrakeal entübasyon tüpü veya trakeostomi kanülü aracılığıyla mekanik ventilasyon ile takip edilirken trakea-özofageal fistül gelişen tüm hastalar dahil edilmiştir. Hastaların yaş, cinsiyet, yoğun bakım ünitesi kabul nedeni, trakea-özofageal fistülün kaçıncı günde gerçekleştiği, trakeostomi uygulaması, mortalite durumu, ilaç kullanımı, trakeal aspirasyon kültüründe üreyen mikroorganizmalar kaydedildi. Bulgular: Toplam 30 hasta çalışmaya dahil edildi. Hastalarda trakea-özofageal fistül geliştiğinde mekanik ventilasyon günü 41,3 gün idi. Trakea-özofageal fistül geliştiğinde 27 hasta 90 trakeostomili iken 3 hastada 10 endotrakeal tüp mevcuttu. Trakeostomi uygulanma günü ise ortalama 21,7 gün idi. Hastaların mekanik ventilasyon süresi ortalama 68,5 gün iken yoğun bakım ünitesi yatış gün sayısı 71,2 gündü. Hastalardan toplam 65 derin trakeal aspirasyon kültürü örneği alındı. 24 hastada 80 trakea-özofageal fistül gelişimi öncesinde trakeal aspirasyon kültüründe üreme varken en sık üreme 26,1 ile klebsiella pneumoniae idi. Hastaların 86,7sinde mortalite gelişirken 13,3 hastanın sıhhat ile taburcu olduğu saptandı. Sonuç: Sonuç olarak yoğun bakım ünitelerinde gelişen trakea-özofageal fistül oldukça mortal seyreden bir komplikasyon olup, bu hastaların büyük çoğunluğunda uzamış mekanik ventilasyon, trakeal aspirasyon kültüründe üreme, steroid kullanımı, hipoalbuminemi, nöromüsküler ilaç kullanımı, yüksek SAPS 3 ve APACHE II skorları olduğunu görmekteyiz.

Article Details

A Fatal Complication in Intensive Care Units: Tracheoesophageal Fistula

Authors:

Fatih Şahin | Havva Kocayigit

Publisher:

Hitit University

Main Topics:

Anesteziyoloji

Journal:

Hitit Medical Journal Vol.7 Issue 2, pp.181-187

Document Type:

Article

Publication Date:

6/2025

Document Language:

English

Document ID (Org No.):

2001351596

pISSN:

2687-4717

Intensive care unit

mechanic ventilation

tracheostomy

Tracheoesophageal FistulaMekanik ventilasyon

trakea-özofageal fistül

trakeostomi

oğun bakım ünitesi

Issues

Article Details

Authors: Fatih Şahin | Havva Kocayigit

Publisher: Hitit University

Main Topics: Anesteziyoloji

Journal: Hitit Medical Journal Vol.7 Issue 2, pp.181-187

Document Type: Article

Publication Date: 6/2025

Document Language: English

Document ID (Org No.): 2001351596

pISSN: 2687-4717

Issues

Authors:

Fatih Şahin | Havva Kocayigit

Publisher:

Hitit University

Main Topics:

Anesteziyoloji

Journal:

Hitit Medical Journal Vol.7 Issue 2, pp.181-187

Document Type:

Article

Publication Date:

6/2025

Document Language:

English

Document ID (Org No.):

2001351596

pISSN:

2687-4717