Introduction
Etiology
Incidence of postextubation laryngeal edema, stridor, and respiratory failure
Postextubation laryngeal edema and stridor
Author | Year | Participants, number | Cases, number | Percentage | Reintubation due to PES/PLE, number | Percentage of participants | Percentage of cases | Reintubation total, number | Percentage of participants |
---|---|---|---|---|---|---|---|---|---|
Postextubation stridor | |||||||||
Colice et al. [1] | 1989 | 82 | 5 | 6.1 % | N/A | N/A | N/A | 9 | 11 % |
Ho et al. [17]a
| 1996 | 38 | 10 | 26.3 % | 1 | 2.6 % | 10 % | N/A | N/A |
Miller and Cole [22] | 1996 | 100 | 6 | 6.0 % | 3 | 3.0 % | 50 % | 17 | 17.0 % |
Epstein and Ciubotaru [3] | 1998 | 745 | N/A | N/A | 11 | 1.5 % | N/A | 74 | 9.9 % |
Sandhu et al. [21] | 2000 | 110 | 13 | 11.8 % | 6 | 5.5 % | 46.2 % | N/A | N/A |
De Bast et al. [2] | 2002 | 76 | 10 | 13.2 % | 8 | 10.5 % | 80 % | 14 | 18.4 % |
Jaber et al. [25]b
| 2003 | 112 | 13 | 11.6 % | 9 | 8.0 % | 69.2 % | 11 | 9.8 % |
Maury et al. [20]b
| 2004 | 99 | 4 | 4.0 % | 1 | 1.0 % | 25.0 % | 18 | 18.2 % |
Kriner et al. [18] | 2005 | 462 | 20 | 4.3 % | 7 | 1.5 % | 35 % | N/A | N/A |
Ding et al. [23] | 2006 | 51 | 4 | 7.8 % | 2 | 3.9 % | 50 % | N/A | N/A |
Cheng et al. [16]c
| 2006 | 236 | 18 | 7.6 % | 10 | 4.2 % | 55.6 % | 14 | 5.9 % |
Lee et al. [30]d
| 2007 | 325 | 25 | 7.7 % | 6 | 1.8 % | 24.0 % | 6 | 1.8 % |
Tadié et al. [14] | 2010 | 136 | 18 | 13.2 % | 4 | 2.9 % | 22.2 % | 17 | 12.5 % |
Cheng et al. [26]c
| 2011 | 113 | 16 | 14.2 % | 11 | 9.7 % | 68.8 % | 14 | 12.4 % |
Gros et al. [27] | 2012 | 104 | 7 | 6.7 % | 6 | 5.8 % | 85.7 % | 29 | 27.9 % |
Sutherasan et al. [15] | 2013 | 101 | 16 | 15.8 % | N/A | N/A | N/A | N/A | N/A |
Mikaeili et al. [28] | 2014 | 41 | 4 | 9.8 % | N/A | N/A | N/A | N/A | N/A |
Abbasi et al. [29]a
| 2014 | 35 | 7 | 20 % | N/A | N/A | N/A | 11 | 31.4 % |
Laryngeal edema | |||||||||
Darmon et al. [12]a
| 1992 | 337 | 17 | 5.0 % | 5 | 1.5 % | 29.4 % | N/A | N/A |
De Bast et al. [2] | 2002 | 76 | 8 | 10.5 % | 8 | 10.5 % | 100 % | 14 | 18.4 % |
Chung et al. [13] | 2006 | 95 | 35 | 36.8 % | N/A | N/A | N/A | N/A | N/A |
François et al. [11]a
| 2007 | 343 | 76 | 22.2 % | 11 | 3.2 % | 14.5 % | 26 | 7.6 % |
Tadié et al. [14] | 2010 | 136 | 74 | 54.4 % | 13 | 9.6 % | 17.6 % | N/A | N/A |
Sutherasan et al. [15] | 2013 | 101 | 17 | 16.8 % | 2 | 2.0 % | 11.8 % | N/A | N/A |
Postextubation respiratory failure
Risk factors
Outcome measure | Study | Year | Risk factors |
---|---|---|---|
Laryngeal injury | Colice et al. [1] | 1989 | Persistent laryngeal neuromotor activity, tracheostomy |
Kastanos et al. [7] | 1983 | Severe respiratory failure, high cuff pressure, duration of endotracheal intubation, secretion infection | |
Esteller-Moré et al. [31] | 2005 | Longer duration of intubation, tracheostomy, number of days in the intensive care unit | |
Laryngeal edema | Darmon et al. [12] | 1992 | Duration of intubation (>36 hours, female gender) |
François et al. [11] | 2007 | Trauma at admission, gender (female), short duration of intubation (<7 days), smaller height-to-tube diameter ratio, absence of methylprednisolone pretreatment | |
Postextubation stridor | Cheng et al. [16] | 2006 | Gender (female), lower Glasgow Coma Scale score, non-sedation treatment |
Sandhu et al. [21] | 2000 | Duration of intubation (>3 days) | |
Daley et al. [32] | 1996 | Tracheostomy, time to reintubation | |
Ho et al. [17] | 1996 | Gender (female) | |
Jaber et al. [25] | 2003 | High SAPS II, medical patients, difficult intubation, history of self-extubation, prolonged intubation, high cuff pressure | |
Kriner et al. [18] | 2005 | Gender (female), duration on intubation (>6 days), ration tube size to laryngeal size >45 % | |
Wang et al. [19] | 2007 | Gender (female) | |
Maury et al. [20] | 2004 | Gender (female) | |
Erginel et al. [33] | 2005 | Duration of ventilation (>5 days), body mass index (>26.5) | |
Reintubation | Daley et al. [32] | 1996 | Tracheostomy, postextubation stidor |
Jaber et al. [25] | 2003 | Postextubation stridor | |
Epstein and Ciubotaru [3] | 1998 | APACHE II score, age, cardiopulmonary cause for reintubation | |
Sandhu et al. [21] | 2000 | Duration of previous intubation (>3 days) |
Assessment of airway patency before extubation
Cuff leak test
Before performing the cuff leak test, first suction endotracheal and oral secretions and set the ventilator in the assist control mode. |
With the cuff inflated, record displayed inspiratory and expiratory tidal volumes to see whether these are similar. Record cuff pressure. |
Deflate the cuff. |
Directly record the expiratory tidal volume over the next six breathing cycles as the expiratory tidal volume will reach a plateau value after a few cycles. |
Average the three lowest values. |
The difference between the inspiratory tidal volume (measured before the cuff was deflated) and the averaged expiratory tidal volume is the cuff leak volume. |
Author | Year | Predefined cutoff value | Outcome | Sensitivity | Specificity | PPV | NPV | |
---|---|---|---|---|---|---|---|---|
Cuff leak test | Volume, ml | Percentage of tidal volume | ||||||
Miller and Cole [22] | 1996 | 110 | Stridor | 0.67 (0.51–0.82) | 0.99 | 0.80 | 0.98 | |
Jaber et al. [25] | 2003 | 130 | 12 | Stridor | 0.85 (0.65–0.99) | 0.95 (0.91–0.99) | 0.69 | 0.98 |
De Bast et al. [2] | 2002 | 15.5 | Reintubation | 0.75 | 0.72 | 0.25 | 0.96 | |
Sandhu et al. [21] | 2000 | 10.0 | Stridor or reintubation | 0.54 | 0.96 | 0.64 | 0.94 | |
Wang et al. [19] | 2007 | 88 | Stridor | 0.60 | 0.89 | 0.55 | 0.91 | |
Maury et al. [20] | 2004 | 0 | Stridor | 1.00 | 0.80 | 0.15 | 1.00 | |
Chung et al. [13] | 2006 | 140 | Laryngeal edema | 0.89 | 0.90 | 0.84 | 0.93 | |
Engoren [34] | 1999 | 110 | Stridor | 0.00 | 0.96 | 0.00 | 0.99 | |
Kriner et al. [18] | 2005 | 110 | Stridor | 0.50 | 0.84 | 0.12 | 0.97 | |
Cheng et al. [16] | 2006 | 18.0 | Stridor | 0.85 | 0.72 | 0.21 | 0.98 | |
Mikaeili et al. [28] | 2014 | 110 | Stridor | 0.25 | 0.84 | 0.14 | 0.91 | |
130 | 0.25 | 0.81 | 0.13 | 0.91 | ||||
249 | 0.75 | 0.59 | 0.17 | 0.96 | ||||
Gros et al. [27] | 2012 | 130 | Stridor | 0.86 (0.42–1.00) | 0.76 (0.67–0.84) | 0.21 (0.08–0.40) | 0.99 (0.93–1.00) | |
Sutherasan et al. [15] | 2013 | 110 | Laryngeal edema | 0.80 | 0.82 | 0.46 | 0.96 | |
Ultrasonography | ACWD, mm | |||||||
Sutherasan et al. [15] | 2013 | 1.6 | Laryngeal edema | 0.71 | 0.70 | 0.32 | 0.92 | |
Mikaeili et al. [28] | 2014 | 0.85 | Stridor | 0.50 | 0.57 | 0.11 | 0.91 |
Ultrasonography
Video laryngoscopy
Prevention
Author | Year | Intervention | Time before extubation | Intervention group | Control group | |||||
---|---|---|---|---|---|---|---|---|---|---|
Outcome parameter | Number | Percentage | Outcome parameter | Number | Percentage |
P value | ||||
Darmon et al. [12] | 1992 | Dexamethasone 8 mg i.v. | 1 hour | Laryngeal edema | 11/327 | 3.4 % | Laryngeal edema | 17/337 | 5.0 % | ns |
Ho et al. [17] | 1996 | Hydrocortisone 100 mg i.v. | 1 hour | Laryngeal edema | 7/39 | 17.9 % | Laryngeal edema | 10/38 | 26.3 % | ns |
Cheng et al. [16] | 2006 | Methylprednisolone 40 mg i.v. | 24 hours | Stridor | 5/43 | 11.6 % | Stridor | 13/43 | 30.2 % | 0.15 |
Reintubation | 3/43 | 6.9 % | Reintubation | 11/43 | 25.6 % | NA | ||||
Methylprednisolone 4 × 40 mg i.v. | 24 hours | Stridor | 3/42 | 7.1 % | Stridor | 13/43 | 30.2 % | 0.005 | ||
Reintubation | 7/42 | 16.7 % | Reintubation | 11/43 | 25.6 % | NA | ||||
François et al. [11] | 2007 | Methylprednisolone 3 × 20 mg i.v. | 12 hours | Laryngeal edema | 11/355 | 3.1 % | Laryngeal edema | 76/343 | 22. % | <0.01 |
Reintubation | 13/355 | 3.7 % | Reintubation | 36/343 | 10.5 % | 0.02 | ||||
Lee et al. [30]a
| 2007 | Dexamethasone 4 × 5 mg i.v. | 48 hours | Stridor | 4/40 | 10 % | Stridor | 11/40 | 27.5 % | 0.037 |
Reintubation | 1/40 | 2.5 % | Reintubation | 2/40 | 5.0 % | 0.56 | ||||
Cheng et al. [26]b
| 2011 | Methylprednisolone 40 mg i.v. | 4 hours | Stridor | 6/38 | 15.8 % | Stridor | 13/33 | 39.4 % | 0.025 |
Reintubation | 3/38 | 7.9 % | Reintubation | 10/33 | 30.3 % | NA | ||||
Abbasi et al. [29] | 2014 | Budesonide 4 × 1 mg nebulized | 48 hours | Respiratory distress | 3/35 | 8.6 % | Respiratory distress | 11/35 | 31.4 % | 0.017 |
Stridor | 3/35 | 8.6 % | Stridor | 7/35 | 20 % | 0.17 | ||||
Reintubation | 3/35 | 8.6 % | Reintubation | 11/35 | 31.4 % | 0.017 |