Chen Weisheng, Li Jiaxin, Deng Ronghua, Chen Chunbo
Department of Emergency Intensive Care Unit, Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, China.
Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Ann Palliat Med. 2021 Apr;10(4):4922-4925. doi: 10.21037/apm-19-681. Epub 2020 Aug 10.
Tracheomegaly and tracheoesophageal fistula (TEF) may be complicated within 12-200 days (with a mean of 43 days) of mechanical ventilation but rare in short-term intubation. Here we present a case of TEF secondary to post-intubation tracheomegaly in a tetanus patient. A 49-year-old male was admitted to the emergency room (ER) and diagnosed with tetanus. He became intubated and mechanically ventilated, but showed over-inflation of the endotracheal tube cuff on X-ray and chest computed tomography since the 8th day. After extubation, the patient had severe coughing during eating. Fiberoptic bronchoscopy and gastroscopy demonstrated a TEF located at the anterior wall of the esophagus. Esophageal exclusion and jejunostomy were performed to heal the fistula. The recurrent and uncontrollable muscular rigidity and spasms might be the main cause early tracheomegaly and TEF. Short-term intubation induced TEF should be aware of in specific patients. Both cuff pressure and cuff volume should be monitored to minimize tracheoesophageal injuries in such cases.
气管扩张症和气管食管瘘（TEF）可能在机械通气12 - 200天内（平均43天）出现并发症，但在短期插管中罕见。在此，我们报告一例破伤风患者插管后气管扩张症继发TEF的病例。一名49岁男性因破伤风入住急诊室，接受了插管和机械通气，但自第8天起，X线和胸部计算机断层扫描显示气管插管套囊过度充气。拔管后，患者进食时出现严重咳嗽。纤维支气管镜和胃镜检查显示TEF位于食管前壁。行食管旷置术和空肠造口术以修复瘘管。反复且无法控制的肌肉强直和痉挛可能是早期气管扩张症和TEF的主要原因。在特定患者中应警惕短期插管引起的TEF。在这种情况下，应监测套囊压力和套囊容积，以尽量减少气管食管损伤。
