“…[ 21 ] Harrow et al . [ 22 ] further reported cases where large mucus plugs resulted in partial tracheal obstruction and in one case report, the mucus plugging of the catheter even resulted in the patient's death due to complete tracheal obstruction. [ 23 ] Similarly, it is noted that patients can often develop mucus impaction leading to dyspnea, therefore indicating the need for frequent TTOT catheter changes.…”