A patient has been receiving positive-pressure ventilation through a tracheostomy tube for 4 days. In the past 2 days, there is evidence of both recurrent aspiration and abdominal distention but minimal air leakage around the tube cuff. What is most likely cause of the problem?

Question

Quizplus · Accepted Answer

Recurrent aspiration and abdominal distention suggest the presence of a tracheoesophageal fistula, which is a communication between the trachea and esophagus. This can lead to the reflux of stomach contents into the lungs and cause abdominal distention. The minimal air leakage around the tube cuff suggests that it is adequately inflated. Paralysis of the vocal cords would not cause these symptoms, and underinflation of the tube cuff would result in air leakage instead of minimal leakage. Tracheoinnominate fistula is a rare complication of tracheostomy and would present with massive bleeding.

A Patient Has Been Receiving Positive-Pressure Ventilation Through a Tracheostomy