An assessment of the tolerability of the Cook staged extubation wire in patients with known or suspected difficult airways extubated in intensive care

Abstract

The Cook staged extubation set (Cook Medical) has been developed to facilitate management of the difficult airway. A guidewire inserted before tracheal extubation provides access to the subglottic airway should re-intubation be required. This prospective cohort study examines patients' tolerance of the guidewire and its impact on clinical status around tracheal extubation in the intensive care unit. Vital signs, incidence of symptoms and patient tolerance of the wire were recorded. Twenty-three patients were enrolled and 17 (73%) tolerated the wire for 4 h. Nasendoscopy was performed in 11 of these patients and revealed one wire was in the oesophagus. The most common symptom was a mild intermittent cough in 13 patients. There was no impact of the guidewire on nursing care in 16 patients, tolerable impact in five and severe impact necessitating removal of the wire in one patient.

Dislocation rates of nasal versus oral airway exchange catheters for postoperative airway management. A prospective case series of 200 patients

“…A small preliminary study suggested high tolerance, as 17 of 23 patients (73%) tolerated the wire for 4 hours, although "tolerated" was not further quantified. 19 Success rate and dislocation rate have not been proven to be different from the conventional AEC: Nasal endoscopy was performed in 11 of these patients and revealed one wire dislocated to the esophagus, which would correspond to a dislocation rate of 9%. In another recent small study, Furyk et al…”

Dislocation rates of postoperative airway exchange catheters - a prospective case series of 200 patients

“…To further improve the tolerance to the AEC, a wire-based AEC is available (Cook Staged Extubation Catheter™, Cook Medical Inc., Bloomington, IN, USA). A small preliminary study suggested high tolerance, as 17 of 23 patients (73%) tolerated the wire for 4 h, although “tolerated” was not further quantified [19]. Success rate and dislocation rate have not been proven to be different from the conventional AEC: Nasal endoscopy was performed in 11 of these patients and revealed one wire dislocated to the esophagus, which would correspond to a dislocation rate of 9%.…”

The reliability of re‐intubation in critical care

“…However, the reliability of the CSES in critically ill patients remains unclear from their work. The authors reported accidental removal of the guidewire in 4 out of 23 cases, one on extubation, one due to cough and two due to patient agitation . A previous study reported a failed intubation rate of 2 out of 23 when the CSES was used to intubate anatomically favourable airways that were adjusted to a Cormack and Lehane Grade 3 or 4 in order to simulate difficulty.…”

“…The focus of McManus et al. 's study was to assess the tolerability of this device in the critically ill population and the authors have provided a useful addition to the literature in this regard .…”