It is occasionally necessary to modify tracheostomy tubes according to specific clinical needs. Two situations commonly require such modifications when tracheostomy cannot be avoided: distal tracheal strictures requiring unusually long cannulae1,2 and restrictive lung disease in infants requiring high pressure ventilation.
In each case, the need to modify existing tubes arises because tracheostomy cannulae of unusual length and bore are commercially unavailable. In the former instance, there is a need for tracheostomy tubes of sufficient length to bypass distal strictures (Fig 1), and in a latter instance, small-bore cuffed tubes for infants are required to provide effective ventilatory support (Fig 2). In this regard, commercially available tracheostomy tubes with cuffs are unavailable in sizes measuring less than 8.5 mm outside diameter (Shiley) and 8.0 mm outside diameter (Portex).
To meet unusual clinical demands, the following techniques of endotracheal tube modification are useful. Standard endotracheal tubes are split proximally using