How is acquired tracheoesophageal fistula (TEF) prevented?

Updated: Nov 07, 2018
  • Author: Sat Sharma, MD, FRCPC; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Patients on prolonged ventilatory support are at risk of developing a tracheoesophageal fistula (TEF). The incidence of TEFs has decreased markedly following the introduction of endotracheal tube cuffs of high volume and low pressure. In critically ill patients, cuff pressure of 30-40 mm Hg may decrease capillary perfusion and result in tissue ischemia. Cuff pressures should be maintained below 25 mm Hg, even at the expense of a small leak. Optimal nutrition and use of flexible, small-caliber nasogastric feeding tubes may be of further help.

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