Borderline extubation and difficult Airway !
Scenario: You decide to extubate morbidly obese patient but parameters are borderline. There is a good air cuff leak. Earlier notes indicate 'difficut intubation' with non-visualization of vocal cords. What could be your option ?
Answers: To extubate over exchange catheter and leave catheter inside respiratory tract till success of extubation is assured. One study showed maintenance of airway upto 72 hours.
Make patient sits 45 to 60 degrees in bed. Explain the discomfort. Preoxygenate with 100% oxygen for about 10 minutes. Check for cuff leak. Pass exchange catheter in ETT as much tolerated gently and extubate. Leave exchange catheter taped to forehead. Another advantage is ventilation with catheter till ETT can be reinserted if required.
References: Click to get articles/abstract
1. The use of an endotracheal ventilation catheter in the management of difficult extubations - Canadian Journal of Anesthesia, Vol 43, 90-93,
2. Airway Management in Critical Illness - Chest. 2007; 131:608-620
3. Extubation of the Patient After a Difficult Intubation - Ann Thorac Surg 1998;65:1778-1780
