The Difficult Airway in Adult Critical Care

Gavin G. Lavery, MD, FCARSCI, MB, BCh, BAO; Brian V. McCloskey, MB, BCh, FRCA, FFARCSI, MRCP


Crit Care Med. 2008;36(7):2163-2173. 

In This Article

Extubation in the Patient with a Difficult Airway (Decannulation)

The patient with a difficult airway still poses a problem at extubation and, if reintubation is necessary, it may be even more difficult than the original procedure. Between 4% and 12% of surgical intensive care unit patients require reintubation[154] and may be hypoxic, distressed, and uncooperative at the time of the procedure. Such patients often have multiple risk factors for difficult intubation[71] as well as airway edema and the presence of dried blood and secretions. Reestablishing the airway in such patients is challenging. Before the extubation of any critical care patient, there should be a strategy that includes a plan for reintubation.

Airway exchange catheters (AEC), which allow gas exchange either by jet ventilation or oxygen insufflation, may be useful in the difficult extubation.[2,155,156] The AEC is placed through the ETT, ensuring that the distal end remains proximal to the carina. The ETT can then be removed after a successful leak test and the AEC may remain in situ until the situation is judged to be stable.[71]


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