• Acquired TOF
• Aetiology
• Malignant
• Oesophageal tumours
  Post surgical
  Pulmonary primaries
  Lymph nodes
  Exacerbated by RXT/CXT
• Non-malignant
• Trauma
  Tracheal tubes
  Intubation
  Percutaneous tracheostomy
  Oesophageal stents
  Poisons/corrosive fluid ingestion
  HIV infection
• Coexisting factors predisposing to development of TOF
• Poor general state
  Airway infection
  Hypotension
  Diabetes
  Long term ventilation
  Posterior pressure by ngt
  Steroids
• Poor prognosis with median survival 1-6/52
• Pathological sequelae:
  Spillage of oesophageal contents
  Congestion
  Infection
  Atelectasis
  Respiratory distress
• Management
• Push ETT beyond fistula if possible
• Acid suppression
• Elevate bed head
• Gastrostomy
• Surgical repair
• Lower cervical incision approach
• May even require tracheal resection
• May need CPB
• May need lung isolation in carinal or bronchial TOF
• Post-op low pressure ventilation or HFOV is used. Aims to extubate immediately
• Palliative stenting may be an option
• Ix
• CXR may show pneumonia, tracheal cuff wider than tracheal diameter if overinflated
• Barium swallow
• Endoscopy
• Oesophagoscopy
• Bronchoscopy
• CEACCP
  Link:ceaccp.oxfordjournals.org/content/6/3/105.full.pdf