La fistola tracheo-esofagea in corso di intubazione tracheale: complicanza e/o responsabilità professionale del rianimatore ?

Acquired benign tracheoesophageal fistula (TEF) is a rare complication of prolonged intubation and tracheostomy. It can occur from variety of causes which include congenital diseases. Among reported risk factors fortracheal damage in in tubated patients, the main origin of TEF is considered high cuff pressure which normally has to be enflated to 30 cm H2O (25 mmHg). The survey of cuff pressure is essential in the preventing this iatrogenic complication. That may be performed directv by using a manometer connected to aspecific external device of the tube or Dy chest radiography. The radiological images help the physician to recognize the correct positioning o f the tube and the cuff volume. Inflated cuff could touch but not distend the tracheal wal. If the ratio of the inflated cuff diameter to the tracheal lumen diameter exceeds 150%, tracheomalacia or TEF are likely to result. Surgical correction is required because spontaneous closure is rare. In the suspect of medical or nursing malpractice, all clinical records of patient have to be available. The gross or histological evidence of fistula may help to definition of etiopathogenesis. The authors describe a special case and review the literature. Evalualion parameters are debated.