Reintubation of the critically ill patients who have risk factors for difficult intubation can be extremely challenging, often resulting in considerable morbidity and mortality. The aim of this study is to determine the usefulness of a pediatric airway exchange catheter (PAEC) prior to tracheal extubation of adult patients who were known to have difficult tracheal intubations and/or have risk factors such as airway obstruction for difficult reintubation.
Patients and methods
Twenty-five study patients at risk for difficult tracheal reintubation were extubated using a No. 11 Cook PAEC. Humidified oxygen was insufflated through the central lumen of PAEC. Signs of respiratory system and tolerance of the patients were also assessed. The PAEC was removed when it became clinically apparent that the need for tracheal reintubation was unlikely. When patients failed to respond to tracheal extubation, the PAEC was used to facilitate reintubation of these difficult airways.
The study population consisted of seven patients undergone neck surgery, seven postoperative patients with maxillofacial trauma, five patients with cerebral infarct, three patients undergone maxillofacial cancer surgery, two patients with head injury and one patient with ankylosing spondylitis. Following tracheal extubation, 2 of 25 patients who undergone neck surgery required reintubation because of excessive airway obstruction due to surgical bleeding and bronchospasm related to aspiration. These patients desaturated progressively and they could not be ventilated properly by face mask after sedatives were given for reintubation. Reintubation was urgently achieved over the Cook PAEC and was easily accomplished on the first attempt without the need of an alternate method.
Extubation of a patient with risk factors for difficult tracheal reintubation is approached with concern, even in the experienced hands of the critical care physician. Mask ventilation and tracheal intubation may be difficult or impossible due to airway obstruction, an agitated patient or cervical immobility. Even under the most controlled circumstances, considerable time may be needed to secure a difficult airway .
The Cook PAEC is a life-saving device for re-intubation in patients not only who are known to have difficult tracheal intubation but also who have risk factors for difficult reintubation that include airway obstruction secondary to surgical manipulation or hematoma.