Tracheostomy tubes are available in both standard and longer lengths. Standard length tubes are generally designed to accommodate patients with normal airway anatomy. However, the length and angulation of standard design tracheostomy tubes may be too short and unsuitable for some critical care patients, risking complications.6
Longer tracheostomy tubes are available with a fixed or adjustable flange (fixed or adjustable length).
Fixed longer length tubes may be elongated in either the proximal portion (between the stoma and the trachea) or the distal portion of the tube (within the trachea).
Extra proximal length is needed for patients with deep set tracheas i.e. large neck due to obesity, goiter, neck mass. Extra distal length is needed for patients with tracheal problems but normal neck anatomy i.e. tracheomalacia, tracheal stenosis.
A flexible (reinforced) tracheostomy tube with an adjustable flange can be used in any of the above patients, although the locking mechanism of the neck flange may prove cumbersome for the patient, making it less suitable for long term use. In these cases, a dual cannula fixed longer length tube with the appropriate proximal or distal extension for the patients anatomy may be more comfortable.