New use of a laryngectomy tube for management of mechanical ventilation in patients with anatomical abnormalities
Tsukuba, Japan
* E-mail: mizutani{at}md.tsukuba.ac.jp
Editor—It is sometimes difficult to manage airways in morbidly obese patients with a thick neck using standard tracheostomy tubes. So far, only a few techniques using tracheostomy tubes or tracheal tubes to manage artificial airways have been reported.1–3 We report successful use of reinforced laryngectomy tubes (LaryngoFlex®, Willy Rusch, Kernen, Germany) with flanges from tracheostomy tubes (ULTRA TracheoFlex®, Willy Rusch, Kernen, Germany) to secure a tracheostomy airway in a patient with serious anatomical abnormalities and severe systemic oedema.
A 72-yr-old male (height, 166 cm; weight, 90 kg), who had undergone laryngectomy for laryngeal carcinoma, was transferred to our intensive care unit (ICU) because of respiratory failure. His trachea was intubated through tracheostomy and his lungs were mechanically ventilated. At first, standard tracheostomy tubes (Portex® Blue Line®, Smith Medical, Kent, UK) 8.0, 9.0, and 10.0 mm ID were used. However, the shape and size of the cuff and the tube length outside the stoma were not appropriate for the patient with a funnel-shape stoma and severe systemic oedema. Then, we tried a laryngectomy tube LaringoFlex® (11.0 mm ID) with a flange derived from a tracheostomy tube ULTRA TracheoFlex® of the same size to place at the optimal depth (Fig. 1). This sealed his trachea and his lungs could be ventilated properly.
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The second patient was a 69-yr-old female (estimated height, 150 cm; weight, 67 kg) with rheumatoid arthritis and its complications. Since she had been intubated orotracheally over a long period, tracheostomy was done. However, the orifice of the stoma could not be accessed easily because of a severe systemic oedema due to chronic cardiac and renal failure. Therefore, as in the first case, we chose LaryngoFlex® 9.0 mm ID with the flange and she was ventilated successfully.
To the best of our knowledge, this is the first report describing the use of a laryngectomy tube with a flange derived from a tracheostomy tube. Standard tracheal tubes are often chosen when tracheostomy tubes are not long enough to access the stoma.1 The laryngectomy tube may overcome several drawbacks, such as proneness to kinking, short cuff length. For example, cuff lengths of LaryngoFlex® and Portex® of 9.0 mm ID are 36 and 26 mm, respectively (Fig. 1). This difference of 10 mm may also be an advantage to seal the trachea properly. Laryngectomy tubes are designed to be used during laryngectomy in the operating room, not during long-term mechanical ventilation in the ICU settings and therefore have no flange. It is usually fixed by an adhesive tape or a suture. This drawback can be overcome by using a flange from TracheoFlex® of the appropriate outer diameter.
In conclusion, we found that a laryngectomy tube with an adapted flange may provide a secure airway during mechanical ventilation via the stoma. We believe that this method is a good alternative to a standard tracheostomy tube for tracheostomized patients with severe anatomical abnormalities.
References
1 Capuano U, Ferrara JJ. A modified endotracheal tube for tracheostomy. Crit Care Med (1986) 14:521–2.[Web of Science][Medline]
2 Headley WB, Rodning CB. Fabricated single lumen tracheal cannula for a morbidly obese patient. J Otolaryngol (1993) 22:438–41.[Web of Science][Medline]
3 Lim PV, Raman R. Adjustable length tracheostomy tube for the morbidly obese and thick neck patient: a prototype. Otolaryngol Head Neck Surg (2001) 124:56–7.[CrossRef][Web of Science][Medline]
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