Patient: My father, 80 years old, suffered a traumatic brain injury 4 months ago, post-injury surgery, post-operative coma for 4 weeks, and tracheotomy the day after surgery. Currently conscious, able to nod and shake his head and write when in good condition. There is not much sputum, no obvious lung infection, and swallowing action. Body temperature was normal and he was fed using nasal feeding. He had been using a primary tracheal tube and then a metal tube, which was removed 2 weeks ago and reintroduced about 24 hours later due to respiratory effort and hypoxia. Now we are using a Tyco primary tracheal tube with a back hole. Theoretically, it is possible to ventilate through the back hole. Today, there was significant dyspnea and even croup in the larynx during inspiration. Due to the patient’s age and mild heart failure. The respiratory effort has a greater impact on cardiac function. What are the possible causes of the difficulty in blocking the tube that you are considering? Are there any good measures to block the tube? Zhang Yinqing, Department of Cerebral Surgery, Jinjiang Hospital of Traditional Chinese Medicine, Jinjiang City, China: Your family is older and has had a longer postoperative pneumonectomy tube. The patient is used to tolerate the tube for a long time, and if you close it all at once, there may be respiratory difficulties soon; 23, strengthen the nutritional support, the key to successful blocking is that the patient is better conscious, good swallowing reflex and cough reflex, if the nutrition can not keep up, the patient is unable to cough, natural blocking is not successful, you can try to enter the liquid food through the mouth a few times to exercise the patient’s swallowing reflex. We have also met many patients who have successfully blocked the tube after three to five times. Finally, it is important to strengthen the physical and speech function rehabilitation training, and it is also helpful to let patients move properly in or out of bed as early as possible.