Figure 1: Prolonged safe extubation (PSE) in a patient with acute respiratory failure after thyroid surgery. Panel a) fiber optic video laryngoscopy through nasal cavity (rlFBS) view shows bilateral adductive vocal cord paresis and a guidewire placed in the airway in order to facilitate a potential emergency re-intubation, while orotracheal tube is removed; panel b) rlFBS view shows an airways exchange catheters (AEC) placed over the guidewire and a nasotracheal cuffless tube (NT)while is getting placed over the AEC; panel c) NT placed under the vocal cords; panel d) the patient adapted in spontaneous breathing with the phonetic valve and NT placed.