Modified Long Tracheostomy Tube for Airway Management in Lower Tracheal Obstruction
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CLINICAL REPORT
Modified Long Tracheostomy Tube for Airway Management in Lower Tracheal Obstruction Anupam Das1 • Chanmiki Sayoo2
Received: 28 July 2020 / Accepted: 19 October 2020 Ó Association of Otolaryngologists of India 2020
Abstract 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. Keywords Emergency airway management Tracheal tumour Long tracheostomy tube
& Chanmiki Sayoo [email protected] Anupam Das [email protected] 1
Department of Head and Neck Surgery, BBCI, Guwahati, India
2
Woodland Hospital Shillong, Shillong, Meghalaya 793003, India
Introduction Acute airway obstruction produces symptoms of dyspnoea, cough, stridor and may be life-threatening due to impending suffocation [1]. A patient may have obstruction due to primary tracheobronchial tumour, a tumour from adjacent structures compressing the airway or metastatic disease to the airway [1]. Obstruction in the airway caused by malignancies in upper airway including nasopharynx, oropharynx, larynx or hypopharynx usually requires surgical intervention such as tracheostomy or cricothyroidotomy [2]. However, an obstruction at the lower tracheal level, tracheostomy and insertion of a regular tracheostomy tube may not alleviate the obstructive symptoms because the limited length of the tube may not bypass the obstruction [3]. Rigid therapeutic bronchoscopic intervention is increasingly accepted to treat such patients for palliation of the airway obstruction [1], but this procedure requires expertise physician and proper facilities which are not commonly available in the emergency department. In such case, Tracheostomy is an easy procedure to perform, but in the absence of a long tube, the obstruction cannot be relieved, as the commonly available tracheostomy tube is only around 6–8 cm long [4]. Even though long tracheostomy tubes are commercially available [5], they are usually expensive and are seldom readily found. A feasible way is to use an endotracheal tube in such cases. However, an endotracheal tube is very uncomfortable and cumbersome to manage, as a substantial length of the tube lays outside the stoma, and it cannot be stabilized to the skin. The neck movement and mobility of the patient is severely affected, and the tube
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