tailieunhanh - Báo cáo y học: "Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients. | Available online http content 13 6 233 Review Clinical review Post-extubation laryngeal edema and extubation failure in critically ill adult patients Bastiaan HJ Wittekamp1 Walther NKA van Mook2 Dave HT Tjan1 Jan Harm Zwaveling2 and Dennis CJJ Bergmans2 1 Department of Intensive Care Gelderse Vallei Hospital Willy Brandtlaan 10 6716 RP Ede The Netherlands intensive Care Centre Maastricht Maastricht University Medical Centre P. Debeyelaan 25 Postbus 5800 6202 AZ Maastricht The Netherlands Corresponding author Bastiaan HJ Wittekamp icuaawittekampb@ Published 1 December 2009 This article is online at http content 13 6 233 2009 BioMed Central Ltd Critical Care 2009 13 233 doi cc8142 Abstract Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. Laryngeal edema may compromise the airway necessitating reintubation. Several studies show that a positive cuff leak test combined with the presence of risk factors can identify patients with increased risk for laryngeal edema. Meta-analyses show that pre-emptive administration of a multiple-dose regimen of glucocorticosteroids can reduce the incidence of laryngeal edema and subsequent reintubation. If post-extubation edema occurs this may necessitate medical intervention. Parenteral administration of corticosteroids epinephrine nebulization and inhalation of a helium oxygen mixture are potentially effective although this has not been confirmed by randomized controlled trials. The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost morbidity and mortality. Introduction Laryngeal edema is a .