A PROSPECTIVE-STUDY OF THE SAFETY OF TRACHEAL EXTUBATION USING A PEDIATRIC AIRWAY EXCHANGE CATHETER FOR PATIENTS WITH A KNOWN DIFFICULT AIRWAY

Study objective: To determine the usefulness of routinely inserting a hollow airway exchange catheter (jet stylet) prior to tracheal extubat ion of adult patients with risk factors for difficult tracheal intubat ion. Design: Prospective, 1-year study of 40 consecutive patients unde rgoing mechanical ventilation who had one or more risk factors for dif ficult tracheal reintubation. Setting: Surgical ICU of a tertiary univ ersity medical center. Interventions: Study patients at risk for diffi cult tracheal reintubation were extubated using a No. 11 Cook airway e xchange catheter (CAEC). Following tracheal extubation, the CAEC was s ecured, and humidified oxygen was insufflated through the central lume n (2 to 8 L/min) for a minimum of 4 h, during which oxyhemoglobin satu ration (SpO(2)) and respiratory frequency were monitored. Strider or o ther signs of respiratory difficulty were also assessed. The CAEC was removed when it became clinically apparent that the need for tracheal reintubation was unlikely. When patients failed to respond to tracheal extubation, the CAEC was used to facilitate reintubation of these dif ficult airways. Results: Respiratory distress necessitating tracheal r eintubation occurred in 3 of 40 patients (8%). One patient failed to r espond to tracheal extubation twice. None of the patients developed ox yhemoglobin desaturation (SpO(2) <90%) before or during tracheal reint ubation. hll four reintubations were accomplished during the first att empt using the CAEC as a stylet. The CAEC was kept in the trachea for a mean duration of 9.4 h. There were no adverse events documented. Con clusions: The No. 11 CAEC is a useful and effective tool for giving pa tients a trial of extubation. Administration of oxygen through the CAE C diminishes the potential for hypoxia while maintaining the ability t o reintubate the trachea, especially when reintubation might prove cha llenging. Previous data suggest that the CAEC is rigid enough to facil itate tracheal reintubation in adults; this was confirmed in the three patients in our study who required tracheal reintubation. The risk of aspiration, barotrauma, or other airway trauma during prolonged place ment of the CAEC appears to be low (zero incidence in 40 patients in t his study), and use of the No. 11 CAEC appeared to be safe. Since oxyg en can be delivered through the CAEC, it may provide a means to safely evaluate an airway during a trial of extubation, ie, a reversible ext ubation. Finally, oxygen administration through the CAEC may obviate t he need for facemask or nasal cannula following tracheal extubation.