Strategy for extubation of the difficult airway:

a protocol and table of airway devices

Hospital Universitario Marina Alta
1 2
Francisca Llobell, MD , Patricia Marzal, MD1, Marisol Echeverri, MD1, Lauren Hoke, BS and Yvon Bryan, MD
1 2
Hospital G. U. Marina Alta, Denia (Alicante), Spain - Wake Forest University Baptist Medical Center, Winston-Salem, NC, US

Background & Goals of Study

Intubation algorithms for patients with difficult airways (DA) and We created extubation protocol in patients with known DA consis-
guidelines for extubation in critical care units exist ting of device table used to bridge the extubation
Standards for extubation of patients with DA’s are vague despite
risk of complications

Methods
Table for extubation of DA divided into 4 quadrants according to function
(Figure 1)
Four quadrants are (clockwise from upper left):
1. Oral, nasal airways, LMA’s to improve oxygenation and ventilation
2. Airway exchange catheters, stylets, guidewires to delay extubation or re-
intubate
3. FFB and Bonfils to visualize glottis
4. Cricothyrotomy kit and TTJV for surgical access

Figure 1

Results
Table 1
Case ID Age Weight Sex Diagnosis Surgery Intubation Extubation
(yrs) (kg) devices devices
1 72 75 M Prostate cancer Radical Airtraq Proseal LMA
Prostatectomy
2 68 60 F Acute abdomen Exploratory FFB nasal CAEC
Laparotomy

3 65 70 M Dysphonia Microsuspension FFB oral CAEC

Laryngoscopy
Microsuspension
4 75 68 M Vocal cord nodule Laryngoscopy Airtraq CAEC

Discussion
Protocol and table of devices during extubations enhanced patient Further research is required in creating extubation protocols in pa-
safety in patients with DA’s tients with DA
Availability of devices at extubation prepares one for different
airway scenarios

Abstract
STRATEGY FOR EXTUBATION OF THE DIFFICULT AIRWAY: A PROTOCOL AND TABLE OF AIRWAY DEVICES
Background and Goals of Study Results
Intubation algorithms for patients with difficult airways (DA) and extubation guidelines in We used the algorithm and table for extubation in 4 patients (see Table 1). No patients ex-
ICU patients exist (1). Extubation of patients with difficult airways is less standardized despi- perienced any complications and the mean time to extubation was 58 (range of 30, 90) mi-
te many complications reported after extubation (2, 3). We created an extubation protocol nutes.
in patients with a known difficult airway consisting of an airway device table used to bridge Discussion
extubation. We present our experience with this protocol and table for extubating patients The protocol and table during extubations enhanced the safety in patients with difficult
with d ifficult airways. airways. The availability of devices at extubation prepares one for different airway scena-
Methods rios. Further research is required regarding extubation protocols in patients with difficult
We created a table for extubation of the difficult airway divided into 4 quadrants according airways.
to function (see Figure 1). By moving clockwise, the four quadrants are; 1) oral and nasal References
airways, LMA’s to improve oxygenation and ventilation; 2) airway exchange catheters, 1) Anesth 2003; 98:1269-77.
stylets, and guidewires to delay extubation or assist in re-intubation ; 3) FFB and Bonfils to vi- 2) Anesth Analg 2007; 105:1182-85.
sualize glottis; 4) cricothyrotomy kit and TTJV for surgical access. 3) Anesth Analg 2007; 105:1357-62.