Laryngotracheal obstruction complicating tracheostomy or endotracheal intubation with assisted respiration. A critical review

Ulcerative tracheo-oesophageal fistula during treatment by tracheostomy and intermittent positive pressure ventilation

Forty-four collected cases of ulcerative tracheo-oesophageal fistula following tracheostomy and assisted ventilation are reviewed. The condition followed this form of treatment in 0·5% of cases and must be distinguished from fistulae caused by accident or surgery, and also from laryngotracheal paralysis or dysfunction. The symptomatology, diagnosis, and treatment are discussed in detail. Spontaneous cure of fistulae is rare, and operative closure should be the aim. In one patient in six, surgical closure is excluded by rapid death. When surgery is possible its timing requires critical judgement. Factors requiring assessment are the condition of the patient and of the tissues around the fistula, the necessity to continue assisted ventilation, and the ability to control nutrition, tracheal aspiration from the mouth or stomach, and pulmonary infection. The mortality of those who did not die too rapidly to receive treatment was 61% without surgery and 45·5% with surgery.