Post Extubation Stridor

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1+2
 
1. Yes, 24 hours, max!
2. yes
3. depends on the inital reasons intubation, if e.g. neck trauma/surgery or similair, then yes, otherwise no if just stridor after too much poking on the vocal cords by e.g. inexperiened intubator
4 sometimes
5. no


________________________________
From: Keith Lamb <lambrrt at gmail.com>
To: International Critical Care Medicine Group <ccm-l at list.pitt.edu> 
Cc: Trauma & Critical Care mailing list <trauma-list at trauma.org> 
Sent: Wednesday, January 4, 2012 9:08 PM
Subject: Post Extubation Stridor

Question about management of the patient with post extubation stridor.

If you extubate a patient and that patient immediately develops upper
airway stridor that is associated with a "moderate"  increase in work of
breathing do you:

1) give aerosolized racemic epinephrine
2) start NIPPV
3) start heliox
4) re-intubate
5) steroids (systemic and or aerosolized)

If the person is re-intubated do you:

1) start a steroid regimen? How long?
2) do you perform cuff leak test before extubating again
3) do you extubate the next time over a tube exchanger or bronchoscope?
4) do you have a "look" with fiberoptics at the supra and sub-glottic
structures before attempting extubation again?
5) Do you routinely obtain CT imaging of the neck soft tissue to help sort
things out?

Thanks,

Keith
-- 
Keith D. Lamb, RRT
RT II, Surgical Critical Care
Christiana Care Health System
Newark, Delaware USA
302.983.6178

Chair, Adult Acute Care Section
American Association for Respiratory Care
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