A 74-year-old man with community-acquired pneumonia underwent intubation and mechanical ventilation for severe respiratory failure. On day 4, a fiberoptic bronchoscopy guided dilatational tracheostomy was performed, and a cannula with a subglottic suction port was placed. As the trachea was deep for neck tissue thickness and kyphosis, it was not possible to insert the cannula more than 2 cm over the cuff. The suction port
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