Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review

Wouter A Pluijms, Walther Nka van Mook, Bastiaan Hj Wittekamp, Dennis Cjj Bergmans, Wouter A Pluijms, Walther Nka van Mook, Bastiaan Hj Wittekamp, Dennis Cjj Bergmans

Abstract

Endotracheal intubation is frequently complicated by laryngeal edema, which may present as postextubation stridor or respiratory difficulty or both. Ultimately, postextubation laryngeal edema may result in respiratory failure with subsequent reintubation. Risk factors for postextubation laryngeal edema include female gender, large tube size, and prolonged intubation. Although patients at low risk for postextubation respiratory insufficiency due to laryngeal edema can be identified by the cuff leak test or laryngeal ultrasound, no reliable test for the identification of high-risk patients is currently available. If applied in a timely manner, intravenous or nebulized corticosteroids can prevent postextubation laryngeal edema; however, the inability to identify high-risk patients prevents the targeted pretreatment of these patients. Therefore, the decision to start corticosteroids should be made on an individual basis and on the basis of the outcome of the cuff leak test and additional risk factors. The preferential treatment of postextubation laryngeal edema consists of intravenous or nebulized corticosteroids combined with nebulized epinephrine, although no data on the optimal treatment algorithm are available. In the presence of respiratory failure, reintubation should be performed without delay. Application of noninvasive ventilation or inhalation of a helium/oxygen mixture is not indicated since it does not improve outcome and increases the delay to intubation.

Figures

Fig. 1
Fig. 1
Proposed extubation algorithm. AEC airway exchange catheter, CLV cuff leak volume. Adapted from Wittekamp et al. [4]

References

    1. Colice GL, Stukel TA, Dain B. Laryngeal complications of prolonged intubation. Chest. 1989;96:877–884. doi: 10.1378/chest.96.4.877.
    1. De Bast Y, De Backer D, Moraine JJ, Lemaire M, Vandenborght C, Vincent JL. The cuff leak test to predict failure of tracheal extubation for laryngeal edema. Intensive Care Med. 2002;28:1267–1272. doi: 10.1007/s00134-002-1422-3.
    1. Epstein SK, Ciubotaru RL. Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med. 1998;158:489–493. doi: 10.1164/ajrccm.158.2.9711045.
    1. Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, Bergmans DC. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009;13:233. doi: 10.1186/cc8142.
    1. Epstein SK. Decision to extubate. Intensive Care Med. 2002;28:535–546. doi: 10.1007/s00134-002-1268-8.
    1. Thille AW, Richard JC, Brochard L. The decision to extubate in the intensive care unit. Am J Respir Crit Care Med. 2013;187:1294–1302. doi: 10.1164/rccm.201208-1523CI.
    1. Kastanos N, Estopa Miro R, Marin Perez A, Xaubet Mir A, Agusti-Vidal A. Laryngotracheal injury due to endotracheal intubation: incidence, evolution, and predisposing factors. A prospective long-term study. Crit Care Med. 1983;11:362–367. doi: 10.1097/00003246-198305000-00009.
    1. Thomas R, Kumar EV, Kameswaran M, Shamim A, Al Ghamdi S, Mummigatty AP. Post intubation laryngeal sequelae in an intensive care unit. J Laryngol Otol. 1995;109:313–316.
    1. Whited RE. A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope. 1984;94:367–377. doi: 10.1288/00005537-198403000-00014.
    1. Mackle T, Meaney J, Timon C. Tracheoesophageal compression associated with substernal goitre. Correlation of symptoms with cross-sectional imaging findings. J Laryngol Otol. 2007;121:358–361. doi: 10.1017/S0022215106004142.
    1. François B, Bellissant E, Gissot V, Desachy A, Normand S, Boulain T, et al. 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial. Lancet. 2007;369:1083–1089. doi: 10.1016/S0140-6736(07)60526-1.
    1. Darmon JY, Rauss A, Dreyfuss D, Bleichner G, Elkharrat D, Schlemmer B, et al. Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. A placebo-controlled, double-blind, multicenter study. Anesthesiology. 1992;77:245–251. doi: 10.1097/00000542-199208000-00004.
    1. Chung YH, Chao TY, Chiu CT, Lin MC. The cuff-leak test is a simple tool to verify severe laryngeal edema in patients undergoing long-term mechanical ventilation. Crit Care Med. 2006;34:409–414. doi: 10.1097/01.CCM.0000198105.65413.85.
    1. Tadié JM, Behm E, Lecuyer L, Benhmamed R, Hans S, Brasnu D, et al. Post-intubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study. Intensive Care Med. 2010;36:991–998. doi: 10.1007/s00134-010-1847-z.
    1. Sutherasan Y, Theerawit P, Hongphanut T, Kiatboonsri C, Kiatboonsri S. Predicting laryngeal edema in intubated patients by portable intensive care unit ultrasound. J Crit Care. 2013;28:675–680. doi: 10.1016/j.jcrc.2013.05.011.
    1. Cheng KC, Hou CC, Huang HC, Lin SC, Zhang H. Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients. Crit Care Med. 2006;34:1345–1350. doi: 10.1097/.
    1. Ho LI, Harn HJ, Lien TC, Hu PY, Wang JH. Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone. Intensive Care Med. 1996;22:933–936. doi: 10.1007/BF02044118.
    1. Kriner EJ, Shafazand S, Colice GL. The endotracheal tube cuff-leak test as a predictor for postextubation stridor. Respir Care. 2005;50:1632–1638.
    1. Wang CL, Tsai YH, Huang CC, Wu YK, Ye MZ, Chou HM, et al. The role of the cuff leak test in predicting the effects of corticosteroid treatment on postextubation stridor. Chang Gung Med J. 2007;30:53–61.
    1. Maury E, Guglielminotti J, Alzieu M, Qureshi T, Guidet B, Offenstadt G. How to identify patients with no risk for postextubation stridor? J Crit Care. 2004;19:23–28. doi: 10.1016/j.jcrc.2004.02.005.
    1. Sandhu RS, Pasquale MD, Miller K, Wasser TE. Measurement of endotracheal tube cuff leak to predict postextubation stridor and need for reintubation. J Am Coll Surg. 2000;190:682–687. doi: 10.1016/S1072-7515(00)00269-6.
    1. Miller RL, Cole RP. Association between reduced cuff leak volume and postextubation stridor. Chest. 1996;110:1035–1040. doi: 10.1378/chest.110.4.1035.
    1. Ding LW, Wang HC, Wu HD, Chang CJ, Yang PC. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study. Eur Respir J. 2006;27:384–389. doi: 10.1183/09031936.06.00029605.
    1. Efferen LS, Elsakr A. Post-extubation stridor: risk factors and outcome. J Assoc Acad Minor Phys. 1998;9:65–68.
    1. Jaber S, Chanques G, Matecki S, Ramonatxo M, Vergne C, Souche B, et al. Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test. Intensive Care Med. 2003;29:69–74.
    1. Cheng KC, Chen CM, Tan CK, Chen HM, Lu CL, Zhang H. Methylprednisolone reduces the rates of postextubation stridor and reintubation associated with attenuated cytokine responses in critically ill patients. Minerva Anestesiol. 2011;77:503–509.
    1. Gros A, Holzapfel L, Marque S, Perard L, Demingeon G, Piralla B, et al. Intra-individual variation of the cuff-leak test as a predictor of post-extubation stridor. Respir Care. 2012;57:2026–2031.
    1. Mikaeili H, Yazdchi M, Tarzamni MK, Ansarin K, Ghasemzadeh M. Laryngeal ultrasonography versus cuff leak test in predicting postextubation stridor. J Cardiovasc Thorac Res. 2014;6:25–28.
    1. Abbasi S, Moradi S, Talakoub R, Kashefi P, Koushki AM. Effect of nebulized budesonide in preventing postextubation complications in critically patients: a prospective, randomized, double-blind, placebo-controlled study. Adv Biomed Res. 2014;3:182. doi: 10.4103/2277-9175.139543.
    1. Lee CH, Peng MJ, Wu CL. Dexamethasone to prevent postextubation airway obstruction in adults: a prospective, randomized, double-blind, placebo-controlled study. Crit Care. 2007;11:R72. doi: 10.1186/cc5957.
    1. Esteller-Moré E, Ibañez J, Matiñó E, Ademà JM, Nolla M, Quer IM. Prognostic factors in laryngotracheal injury following intubation and/or tracheotomy in ICU patients. Eur Arch Otorhinolaryngol. 2005;262:880–883. doi: 10.1007/s00405-005-0929-y.
    1. Daley BJ, Garcia-Perez F, Ross SE. Reintubation as an outcome predictor in trauma patients. Chest. 1996;110:1577–1580. doi: 10.1378/chest.110.6.1577.
    1. Erginel S, Ucgun I, Yildirim H, Metintas M, Parspour S. High body mass index and long duration of intubation increase post-extubation stridor in patients with mechanical ventilation. Tohoku J Exp Med. 2005;207:125–132. doi: 10.1620/tjem.207.125.
    1. Engoren M. Evaluation of the cuff-leak test in a cardiac surgery population. Chest. 1999;116:1029–1031. doi: 10.1378/chest.116.4.1029.
    1. Antonaglia V, Vergolini A, Pascotto S, Bonini P, Renco M, Peratoner A, et al. Cuff-leak test predicts the severity of postextubation acute laryngeal lesions: a preliminary study. Eur J Anaesthesiol. 2010;27:534–541.
    1. Prinianakis G, Alexopoulou C, Mamidakis E, Kondili E, Georgopoulos D. Determinants of the cuff-leak test: a physiological study. Crit Care. 2005;9:R24–R31. doi: 10.1186/cc3012.
    1. Newmark JL, Ahn YK, Adams MC, Bittner EA, Wilcox SR. Use of video laryngoscopy and camera phones to communicate progression of laryngeal edema in assessing for extubation: a case series. J Intensive Care Med. 2013;28:67–71. doi: 10.1177/0885066612437528.
    1. Rose L, Redl L. Survey of cuff management practices in intensive care units in Australia and New Zealand. Am J Crit Care. 2008;17:428–435.
    1. Lorente L, Lecuona M, Jimenez A, Lorenzo L, Roca I, Cabrera J, et al. Continuous endotracheal tube cuff pressure control system protects against ventilator-associated pneumonia. Crit Care. 2014;18:R77. doi: 10.1186/cc13837.
    1. Roberts RJ, Welch SM, Devlin JW. Corticosteroids for prevention of postextubation laryngeal edema in adults. Ann Pharmacother. 2008;42:686–691. doi: 10.1345/aph.1K655.
    1. Khemani RG, 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
    1. Lin C, Yu H, Fan H, Li Z. The efficacy of noninvasive ventilation in managing postextubation respiratory failure: a meta-analysis. Heart Lung. 2014;43:99–104. doi: 10.1016/j.hrtlng.2014.01.002.
    1. Esteban A, Frutos-Vivar F, Ferguson ND, Arabi Y, Apezteguia C, Gonzalez M, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. N Engl J Med. 2004;350:2452–2460. doi: 10.1056/NEJMoa032736.
    1. Group DASEG, Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012;67:318–340. doi: 10.1111/j.1365-2044.2012.07075.x.
    1. Dark A, Armstrong T. Severe postoperative laryngeal oedema causing total airway obstruction immediately on extubation. Br J Anaesth. 1999;82:644–646. doi: 10.1093/bja/82.4.644.
    1. Hamaekers AE, Borg PA, Enk D. Ventrain: an ejector ventilator for emergency use. Br J Anaesth. 2012;108:1017–1021. doi: 10.1093/bja/aes033.
    1. Argent AC, Hatherill M, Newth CJ, Klein M. The effect of epinephrine by nebulization on measures of airway obstruction in patients with acute severe croup. Intensive Care Med. 2008;34:138–147. doi: 10.1007/s00134-007-0855-0.
    1. Bjornson C, Russell K, Vandermeer B, Klassen TP, Johnson DW. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev. 2013;10
    1. MacDonnell SP, Timmins AC, Watson JD. Adrenaline administered via a nebulizer in adult patients with upper airway obstruction. Anaesthesia. 1995;50:35–36. doi: 10.1111/j.1365-2044.1995.tb04510.x.
    1. Cesar RG, de Carvalho WB. L-epinephrine and dexamethasone in postextubation airway obstruction: a prospective, randomized, double-blind placebo-controlled study. Int J Pediatr Otorhinolaryngol. 2009;73:1639–1643. doi: 10.1016/j.ijporl.2009.08.004.
    1. Kemper KJ, Ritz RH, Benson MS, Bishop MS. Helium-oxygen mixture in the treatment of postextubation stridor in pediatric trauma patients. Critical Care Med. 1991;19:356–359. doi: 10.1097/00003246-199103000-00013.

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