Abstract Post‐extubation respiratory failure in patients with difficult airway is considered a challenge for the health team. Some intratracheal devices such as airway exchange catheters (AECs) could be used during scheduled tube removing to ensure a rapid access to airway in the case of requiring emergent reintubation. Nevertheless, using such devices could impede adequate non‐invasive mechanical ventilation (NIMV) support because of the air leaks generated by interfering with mask interfaces. We describe the case of a woman with a very difficult airway in whom an AEC was placed before scheduled extubation and then developed post‐extubation respiratory failure. Mask interface was adequately sealed by using a novel tube adapter for NIMV and successful non‐invasive ventilation was provided while maintaining the AEC placed in the trachea until the emergency reintubation risk was overcome.