Tracheo-esophageal fistula secondary to tracheostomy, delayed diagnosis

Persistent air leak is not a common problem in patients who are under mechanical ventilation support; however, it can be encountered in intensive care unit (icu). it is often due to nonuniform contact between the cuff and the tracheal wall caused by insufficient cuff pressure or malposition of the tube. tracheostomy is commonly applied and is a relatively safe invasive procedure in icu. we report a case of tracheoesophageal fistula (tef), secondary to tracheostomy, initially manifested with persistent air leak under mechanical ventilation in icu. consequently, tef should be considered in patients with unexplained upper airway leaks.