Unusual case of guide wire traverse of endotracheal tube cuff during percutaneous tracheostomy

Although the use of endotracheal tube for airway control during percutaneous dilatational tracheostomy provides better airway seal, it also carries the risk of damage to cuff from the needle. This report highlights a case where the guide wire entered the trachea after traversing the cuff without associated air leak. Use of a [tug test] allowed detection of the cuff impalement by the guide wire