Nursing Management of Repeated Extubation Failure Following Colonic Volvulus Surgery in a Patient with Alstrom...

Alstrom syndrome is a rare genetic disorder characterized by multi-system involvement, including metabolic, sensory, and cardiorespiratory impairments. Patients undergoing major surgery are at high risk of respiratory complications, though reports of repeated extubation failure are scarce.

An 18-year-old male with a previous diagnosis of Alström syndrome was admitted for acute abdominal pain and diagnosed with colonic volvulus. An emergency exploratory laparotomy was performed, which included the reduction and decompression of the colonic volvulus, followed by a partial sigmoidectomy and stoma formation. Postoperatively, the patient was transferred to the ICU and experienced two episodes of extubation failure requiring reintubation. The failures were considered multifactorial, involving impaired airway clearance, limited cooperation with coughing and expectoration, secretion retention, possible aspiration risk, and concomitant pulmonary infection. Multidisciplinary interventions were implemented, including intensified inflammatory monitoring, secretion management, and systematic pre-extubation evaluation.

Under coordinated medical and nursing care, tailored airway management was performed, including bronchoscopic hygiene, pharmacologic reduction of secretions, and continuous monitoring of infection markers. After a structured weaning process, the patient was successfully extubated on the third attempt and was eventually discharged in stable condition.

This case presents our clinical experience with repeated extubation failures in a patient with Alstrom syndrome following abdominal surgery, highlighting the profound complexities of postoperative airway management. It suggests that a multidisciplinary approach emphasizing vigilant infection control, personalized respiratory care, and systematic weaning planning proved essential for successful extubation in this specific complex scenario.