Aspiration of a tracheostomy plug

A plastic truncated conical tracheostomy plug passed down the outer cannula of a Jackson tracheostomy tube and into the lungs of a respirator-dependent man during the monthly change of the inner cannula. Despite repeated flexible and rigid bronchoscopic visualization, attempts at dislodgement were unsuccessful. An exploratory thoracotomy was also unsuccessful in recovering the plug. Seventeen days postaspiration, with percussion and postural drainage, the patient expectorated the plug, even in the absence of the cough reflex. Such plugs have now been modified by passing a ring through the hole to prevent aspiration.