Modified Long Tracheostomy Tube for Airway Management in Lower Tracheal Obstruction

Tracheostomy is the primary surgical procedure to overcome acute respiratory distress due to upper airway obstruction. The design of tracheostomy tubes are for management of obstruction usually above the level of the glottis or cricoid cartilage. Infrequently, we come across patients who present with respiratory difficulty due to obstruction at lower levels of the trachea. In such patients, tracheostomy may not alleviate the obstructive symptoms as the limited length of the tube may not bypass the obstruction. There is a dearth of long tracheostomy tubes commercially. They are usually not readily available and costly. We present a method to combine and modify an endotracheal tube and a tracheostomy tube to fashion them into a Long Tracheostomy Tube. We also present two cases where we used the long tracheostomy tubes in an otherwise difficult to manage scenarios.