Department of Department of Biotechnology and Life Sciences, University of Insubria, ItalyFulltext PDF
Introduction: COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2, led to an increase in intensive care admission for massive interstitial pneumonia. Many patients underwent long periods of endotracheal intubation for mechanical ventilation and subsequent tracheostomy. The most common complications related to these maneuvers are known: Laryngotracheal granulomas, webs, stenosis and malacia. Less common complications are tracheal necrosis with trachea-esophageal or tracheoarterial fistulas, caused by compression between the orotracheal tube cuff and the nasogastric tube. Case Report: We present the case of a patient with severe COVID-19 associated pneumonia who underwent orotracheal intubation and prolonged mechanical ventilation for two months with unexplained episodes of food inhalation. During the swallowing test, it was observed inhalation, without natural passage of food from the glottic plane. Therefore, ENT specialist in swallowing, suspecting the feared tracheoesophageal fistula, requested a double contrast esophageal X-ray that confirmed the diagnostic hypothesis. Thoracic surgery team performed surgical correction by resection and tracheal anastomosis with esophago raffia. Discussion: TEF is a very rare, but potentially fatal, complication of invasive VM. Predisposing factors are prolonged periods of invasive VM, elevated cuff pressures, oversized endotracheal tubes, patient comorbidities, local and general infections, and use of a nasogastric tube. The endoscopic swallow test is a relatively simple test, performed at the patient's bed that can identify oropharyngeal swallowing disorders and esophageal changes, such as tracheoesophageal fistula
Elli F. Post-Intubation Tracheoesophageal Fistula in Severe SARS-CoV-2 - COVID-19 Patient: Unexpected Finding during Swallowing Test. Am J Otolaryngol Head Neck Surg. 2022; 5(5):1192.