Update on postextubation laryngeal edema
Keywords:
postextubation laryngeal edema, laryngeal ultrasound, steroidsAbstract
Endotracheal intubation is frequently complicated by laryngeal edema, which can present as post-extubation stridor and/or respiratory distress, which can lead to respiratory failure requiring reintubation. The objective of this work is to update the knowledge about post-extubation laryngeal edema. For this, a search for information was carried out on web pages such as the World Health Organization and Infomed, and in databases such as Scielo, PubMed Central, Medline and Medscape in the period between January 2021 to June 2021, finding a total of 120 articles, where the large endotracheal tube and prolonged intubation are defined as data relevant to the female gender as risk factors for post-extubation laryngeal edema. Although patients at low risk for this complication can be identified using the cuff leak test and, more recently, laryngeal ultrasound, there is currently no reliable test for the identification of high-risk patients. Concluding that in patients with positive CLT, the decision to start pretreatment with corticosteroids should be made individually and based on the presence of additional risk factors, if the use of them is considered, treatment should be started at the same time. at least four hours before extubation and multiple doses should be administered, the combination of treatment with nebulized epinephrine being the choice, without postponing reintubation if necessary.
References
Pluijms W, Mook Wv, Wittekamp B. Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review. Critical Care. 2015;19.
Ahmed TS, Khaled ZK, Eltatawy SA. Predicting laryngeal edema and stridor utilizing cuff leak test vs laryngeal air column width difference: Systematic review and meta-analysis. Chest. 2018;154(45).
Torres-Gallardo B, Bergé R, Sala-Blanch X. Descripción anatómica de las ventanas laríngeas ecográficas. Rev Esp Anestesiol Reanim. 2015;62:297-8.
Chen W, Chen J, Wang H, Chen Y. Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit. Journal of International Medical Research. 2019;0:1-10.
El-Baradey G, EL-Shmaa N, Elsharawy F. Ultrasound-guided laryngeal air column width difference and the cuff leak volume in predicting the effectiveness of steroid therapy on postextubation stridor in adult. Are they useful? Journal of Critical Care. 2016.
Maury E, Guglielminotti J, Alzieu M. How to Identify Patients With No Risk for Postextubation Stridor? Journal of Critical Care. 2004;19(1):23-8.
Borhazowal R, Harde M, Bhadade R. Comparison between Two Endotracheal Tube Cuff Inflation Methods; Just-Seal Vs Stethoscope-Guided. Journal of Clinical and Diagnostic Research. 2017;11.
Benjamin B. Prolonged Intubation Injuries Of The Larynx: Endoscopic Diagnosis, Classification, And Treatment. Annals of Otology, Rhinology & Laryngology. 2018;127(8).
Kemper K, Benson M, Bishop M. Predictors of postextubation stridor in pediatric trauma patients. Critical Care. 1991;19.
Koka B, Jeon I, Andre J. Postintubation croup in children. Anaesth Analg 1977;4.
Rodriguez B, Dessauer GBV, Duffau TG. Laringitis posextubación. Rev Chil Pediatr. 2002;73(2).
Pérez-Herrero M, Varga Odl, Flores M. Imágenes ultrasonográficas de vía aérea superior tras la inserción de mascarilla laríngea: estudio descriptivo y utilidad clínica. Rev Esp Anestesiol Reanim. 2018;65(8).
Deakers T, Reynols G, Stretton M. Cuffed endotracheal tubes in pediatric intensive care. J Pediatrics. 1994;125(57).
Prada G, Baron A, Martin A. Tracheal, Lung, and Diaphragmatic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care. Journal of Cardiothoracic and Vascular Anesthesia 2019:1-13.
Backer DD. The cuff-leak test: what are we measuring? Critical Care. 2005;9:31-3.
Prinianakis G, Alexopoulou C, Mamidakis E. Determinants of the cuff-leak test: a physiological study. Critical Care. 2005;9:24-31.
Lewis K, Culgin S, Jaeschke R, Perri D. Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients (COMIC): a pilot randomised controlled trial protocol. BMJ Open. 2019;9.
Sutherasan Y, Theerawit P, Hongphanut T. Predicting laryngeal edema in intubated patients by portable intensive care unit ultrasound. Journal of Critical Care. 2013;28:675–80.
Blanco P. Ecografía clínica: simple sí, fácil no. Rev Hosp Emilio Ferreyra. 2020;1(1):1-4.
Ding L, Wang H, Wu H. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study. Eur Respir J. 2006;27:384–9.
Mikaeili H, Yazdchi M, Tarzamni M. Laryngeal Ultrasonography Versus Cuff Leak Test in Predicting Postextubation Stridor. J Cardiovasc Thorac Res. 2014;6:25-8.
Roberts R, Welch S, Devlin J. Corticosteroids for prevention of postextubation laryngeal edema in adults. . Ann Pharmacother. 2008;42.
Khemani R, Randolph A, Markovitz B. Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults. Cochrane Database Syst Rev. 2009;8.
Quintard H, l’Her E, Pottecher J. Intubation and extubation of the ICU patient. Anaesth Crit Care Pain Med. 2017;36:327–41.
Wong P, WY. Lim. Aligning difcult airway guidelines with the anesthetic COVID 19 guidelines to develop a COVID 19 difcult airway strategy: a narrative review. Journal of Anesthesia 2020.
McGrath BA, Wallace S, Goswamy J. Laryngeal oedema associated with COVID-19 complicating airway management. Anaesthesia. 2020;75:962-77.
Shirley F, Oshri W, Ari D. The role of laryngeal ultrasound in the assessment of pediatric dysphonia and stridor. International Journal of Pediatric Otorhinolaryngology 2019;122:175–9.
Downloads
Published
How to Cite
Issue
Section
License
Los autores conservan los derechos de autor y todos los derechos de publicación sin restricciones.
Investigaciones Medicoquirúrgicas se encuentra sujeta bajo la Licencia Creative Commons Atribución-No Comercial 4.0 Internacional (CC BY-NC 4.0) y sigue el modelo de publicación de SciELO Publishing Schema (SciELO PS) para la publicación en formato XML.
Usted es libre de:
- Compartir — copiar y redistribuir el material en cualquier medio o formato
- Adaptar — remezclar, transformar y construir a partir del material.
La licencia no puede revocar estas libertades en tanto usted siga los términos de la licencia
Bajo los siguientes términos:
- Atribución — Usted debe dar crédito de manera adecuada, brindar un enlace a la licencia, e indicar si se han realizado cambios. Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugiera que usted o su uso tienen el apoyo de la licenciante.
- No Comercial — Usted no puede hacer uso del material con propósitos comerciales.
- No hay restricciones adicionales — No puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otras a hacer cualquier uso permitido por la licencia.
Avisos:
- No tiene que cumplir con la licencia para elementos del material en el dominio público o cuando su uso esté permitido por una excepción o limitación aplicable.
- No se dan garantías. La licencia podría no darle todos los permisos que necesita para el uso que tenga previsto. Por ejemplo, otros derechos como publicidad, privacidad, o derechos morales pueden limitar la forma en que utilice el material.
