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?
a. Paralysis of the vocal cords
b. Underinflated tube cuff
c. Tracheoesophageal fistula
d. Tracheoinnominate fistula

ANS: C
Diagnosis can be made by a history of recurrent aspiration and abdominal distention as air is forced into the esophagus during positive-pressure ventilation.