ICU · Airway management

Extubation & Its Complications — Stridor, Laryngospasm, Pulmonary Oedema

Also known as Extubation · Extubation failure · Post-extubation stridor · Laryngeal oedema · Laryngospasm · Larson manoeuvre · Cuff leak test · Rapid shallow breathing index · Negative-pressure pulmonary oedema · Post-obstructive pulmonary oedema · Reintubation · Post-extubation dysphagia · Unplanned extubation · Airway-exchange catheter

Extubation is the planned removal of the endotracheal tube once a spontaneous breathing trial is tolerated and airway protection is adequate; it carries a 10-20 per cent reintubation rate. The serious complications are post-extubation stridor (laryngeal oedema — predicted imperfectly by the cuff-leak test, reduced by prophylactic methylprednisolone or dexamethasone in high-risk patients), laryngospasm (treat with 100 per cent oxygen, CPAP, the Larson manoeuvre and jaw thrust; a small dose of suxamethonium if refractory), negative-pressure pulmonary oedema from forceful inspiration against a closed glottis, aspiration of subglottic secretions, post-extubation dysphagia (pooled incidence around 41 per cent), and unplanned extubation. Plan high-risk extubations with senior presence, steroid pretreatment and an airway-exchange catheter, and treat every planned extubation as a potential difficult reintubation.