Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

Wittekamp, Bastiaan H J; Mook, Walther N. K. A. van; Tjan, D H T; Zwaveling, JH; Bergmans, Dennis C. J. J.

doi:10.1186/cc8142

Cited by 140 publications

(115 citation statements)

References 52 publications

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“…It is imperative that anesthesia providers remain extra vigilant in assessing the readiness of the obese patient, as reintubation has clearly been shown to be associated with higher mortality and morbidity. 18 Historically, patients undergoing trial extubation are brought to the operating room. In the presence of a qualified surgeon to perform an emergent tracheostomy, the patient is evaluated for potential extubation.…”

Section: Discussionmentioning

confidence: 99%

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Use of Glidescope in Trial Extubation of the Difficult Airway

Khurmi¹,

Cubillo²,

Desk³

2017

SDRP-JAS

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ABSTRACT:It is not uncommon for patients to arrive in the operating suites with potential airway issues. These patients include pregnant woman, patients with cervical spine arthritis, the morbidly obese and patients who have had multiple and prolonged intubations. An estimated 40% of the adult population is deemed to be obese based on Body Mass Index. 12 Many intubated patients experience a degree of laryngeal edema or swelling (see figure 1 and 2). However, symptoms typically remain subclinical. Frequent laryngoscopy can lead to laryngeal edema and trauma. The duration of endotracheal intubation is directly correlated to degree of edema. Intraoperative fluid management and fluid shifts can also aggravate laryngeal edema. Early reintubation (0-72 hours post-extubation) occurs about 12% of the time. 5 Safely managing a difficult airway (expected or unexpected) is critical to the overall well-being of the patient. Many evaluations and precautions are taken at the onset of an anesthetic. One should be just as vigilant at the conclusion of an anesthetic involving a challenging airway to avoid post-extubation complications. While guidelines to safely plan and perform extubation exist, the use of modern technology seems to be less prevalent. Using a video laryngoscope to evaluate the airway prior to extubation can be a valuable adjunct in the overall assessment of readiness to extubate a patient. In this report we describe a case of failed extubation and the ultimate use of video laryngoscopy to assist in the decision making process to extubate or perform a tracheostomy.KEY WORDS: difficult airway, extubation, video laryngoscope, obesity KEY MESSAGES: In the setting of a known or suspected difficult airway, a video laryngoscope should be on the short list of tools that can be used to successfully extubate the patient.

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Section: Discussionmentioning

confidence: 99%

“…Interestingly, airway obstruction as a cause for reintubation is associated with a lower mortality rates compared with non-airway causes for reintubation (see figure 3). 18 Figure 3: Incidence of reintubation and mortality 18 SDRP Journal Of Anesthesia & Surgery February 20, 2016 Narjeet Khurmi 3 www. siftdesk.…”

Section: Incidencementioning

confidence: 99%

Use of Glidescope in Trial Extubation of the Difficult Airway

Khurmi¹,

Cubillo²,

Desk³

2017

SDRP-JAS

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“…Stridor is treated effectively with an aerosol treatment of racemic epinephrine 2.25% (22.5 mg/mL in 3 mL of normal saline). 29 …”

Section: Extubation Considerationsmentioning

confidence: 99%

Ensuring Breathing Comfort at the End of Life: The Integral Role of the Critical Care Nurse

Campbell

2018

American Journal of Critical Care

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This article describes the author’s program of clinical research focused on assessment and treatment of respiratory distress among critically ill patients at the end of life. Dyspnea is a subjective experience of breathing discomfort that occurs in the presence of cardiopulmonary and neuromuscular diseases. Dyspnea is one of the most common and most distressing symptoms experienced by critically ill patients. Many critically ill patients, particularly those not expected to survive, become cognitively impaired or unconscious and lose the ability to report symptoms, although dyspnea can be known only from a patient’s report. When self-reporting ability is lost, the critical care nurse must rely on signs indicative of a patient’s respiratory distress. The critically ill patient unable to self-report is vulnerable to under-recognition of symptom distress and subsequent over-treatment or undertreatment. When the patient is dying, there is only 1 chance to optimize the assessment and treatment of symptoms.

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“…In the former case, larynx edema is a frequently observed cause of airway obstruction in the ICU and during the postoperative period. On the other hand, in the latter case, the factors contributing to airway obstructions include comorbid diseases, type of disease, and postoperative management (5)(6)(7)(8). This can serve as guidance for clinicians regarding the time for which patients having difficult airways and extubation failure risk in the ICU should be monitored and the duration for which airway exchange catheters should be used, when necessary (9).…”

Section: Determination Of Extubation Failure Riskmentioning

confidence: 99%