A frequent, potentially life-threatening complication of fenestrated tracheostomy tubes is tracheal wall obstruction of the fenestration. The anatomy of each patient determines the proper position of the fenestration on the tube, and we have found that 4 out of 5 tracheostomized patients in our institution benefit from custom-cut fenestrations. We routinely individualize the placement of the fenestration, and use the fiberoptic laryngoscope to examine fenestrated tracheostomy tubes in situ to detect possible obstruction of the fenestration.
