Dislodged Tracheostomy in Obese ICU Patient

You are the duty consultant anaesthetist at a tertiary hospital. You are called to come immediately to the intensive care unit (ICU) to help other medical staff struggling with the airway management of a patient with a tracheostomy. On arrival you see: - the ICU consultant attempting to insert a laryngeal mask airway (LMA) - an ear, nose and throat (ENT) surgical registrar attempting to replace the tracheostomy tube - oxygen saturation SpO2 86% - heart rate 122 beats per minute - blood pressure 195 / 115 mmHg The ICU consultant tells you this is a 55-year-old man weighing 165kg who has community-acquired pneumonia. The patient had a surgical tracheostomy three days ago. The tracheostomy tube has now become dislodged while turning the patient.