M. M. Treggiari, M.D., Ph.D., M.P.H.
There is little information on the approach to removal of endotracheal tube in patients with difficult airway. Data on the circumstances, techniques and safety of extubation strategies are also lacking. An evaluation of difficult airway management within the Closed Claim project identified severe injuries occurring among patient requiring re-intubation after failed extubation, and concluded that the development of management strategies covering emergence and the recovery phase post-extubation may improve patient safety 1. Requirement for re-intubation after surgical procedures involved neck swelling with respiratory distress after cervical fusion and other neck surgeries, or fluid extravasation from a central catheter. Interestingly, most of the claims from extubation failure were in cases of potentially predictable difficulties including difficult intubation on induction, obesity and/or sleep apnea.
Patients with a known or suspected difficult airway and at high risk of extubation failure represent a patient cohort who requires careful monitoring and may benefit from a planned extubation strategy involving reversible extubation.
The primary aims of the present study are to: (1) investigate the occurrence of extubation failure in a population of intubated patients requiring ICU admission; (2) identify subgroups of patients with anticipated and known difficult airways; (3) estimate the size of the population with difficult reintubation; and (4) the incremental cost associated with extubation failure. Secondary aims include the evaluation of the circumstances, techniques and complications of re-intubation.