Converting from an endotracheal tube to tracheostomy: description of a proposed alternative approach.

Replacing an existing endotracheal (ET) tube with a tracheostomy tube can be a challenging and high-risk procedure for the patient, surgeon, anesthetist, and operating room staff. This article describes an approach designed to reduce the risks involved and, at the same time, provide a safe, efficient, and simplified approach to surgically securing the airway. Before surgical entry into the trachea, the ET tube is advanced just proximal to the carina and the ET cuff reinflated. This approach has been used extensively at an academic medical center's operating room without reports of outcome failure or complications. A review of the literature revealed occasional, unreferenced mention of "advancing the tube forward," but the current report is the first detailed description of the procedure to appear in the literature.