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A Structured Approach to Extubation in Mechanically Ventilated Rats
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An Extubation Protocol for Angioedema.

Elizabeth Floyd1, Nira A Goldstein1, Rauno Joks2

  • 1Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn New York, USA.

OTO Open
|November 28, 2018
PubMed
Summary
This summary is machine-generated.

Angiotensin-converting enzyme inhibitor-induced angioedema often requires intubation. The endotracheal tube cuff-leak test and laryngoscopy help determine safe extubation timing for these patients.

Keywords:
angioedemaangiotensin-converting enzyme inhibitorcuff leakdirect laryngoscopy

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Area of Science:

  • Otolaryngology
  • Emergency Medicine
  • Pulmonology

Background:

  • Angioedema, characterized by non-pitting edema of mucous membranes and skin, is a common complication of angiotensin-converting enzyme (ACE) inhibitor use.
  • Severe angioedema can lead to airway compromise, necessitating endotracheal intubation.

Purpose of the Study:

  • To evaluate the utility of the endotracheal tube cuff-leak test and bedside direct laryngoscopy in determining extubation readiness for patients intubated due to angioedema.
  • To establish simple, cost-effective methods for managing airway edema in ACE inhibitor-induced angioedema.

Main Methods:

  • Prospective data collection of patients presenting with angioedema to the emergency department.
  • Analysis of intubation duration and the application of endotracheal tube cuff-leak tests and bedside direct laryngoscopy prior to extubation.
  • Fiberoptic intubation was used in a subset of patients requiring airway support.

Main Results:

  • Of 76 patients with angioedema, 9 required intubation, with a median intubation duration of 73 hours.
  • The endotracheal tube cuff-leak test was performed in 7 patients, and bedside direct laryngoscopy in 3 of these patients.
  • These tests were utilized to assess the resolution of laryngeal edema and confirm extubation eligibility.

Conclusions:

  • The endotracheal tube cuff-leak test and bedside direct laryngoscopy are practical and inexpensive tools for assessing extubation readiness in angioedema patients.
  • These methods can aid otolaryngology departments in safely managing patients with airway edema secondary to ACE inhibitor use.
  • Implementing these bedside assessments can improve patient outcomes and streamline the extubation process.