Dangerous misalignment of tracheostomy tube in a dystonic patient.

A 64-year-old woman with multiple system atrophy presented with acute severe dyspnoea. She was bedridden for 4 years because of progressive cerebellar ataxia, parkinsonism and autonomic failure, and had respiratory disturbance. She had undergone tracheostomy 3 years earlier and had recently experienced several episodes of transient dyspnoea. Passing a suction catheter through her tracheostomy tube was difficult. A CT scan revealed that the curvature of the tracheostomy tube did not align with her trachea. The orifice of the tube was partly obstructed by …