A 67-year-old ventilator-dependent patient developed acute respiratory decompensation caused by the herniation of the overdistended tracheostomy tube cuff. The patient also had a markedly high ratio of cuff diameter to trachea diameter, presumably due to tracheomalacia. To overcome the problem of providing an adequate airway while positioning the cuff at a tracheal site that was not damaged, we improvised and developed an apparatus consisting of a regular #10 Shiley tracheostomy tube with a #8 Tartan endotracheal tube passed through it. This improvised device was easy to assemble and allowed us to tide the patient over during the acute phase of his problem. (Respir Care 1985;30:95-97.)
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