A prospective study of the safety of tracheal extubation using a pediatric airway exchange catheter for patients with a known difficult airway.

@article{Loudermilk1997APS,
  title={A prospective study of the safety of tracheal extubation using a pediatric airway exchange catheter for patients with a known difficult airway.},
  author={Eric Loudermilk and M W Hartmannsgruber and Daniel P. Stoltzfus and Paul B. Langevin},
  journal={Chest},
  year={1997},
  volume={111 6},
  pages={
          1660-5
        }
}
STUDY OBJECTIVE To determine the usefulness of routinely inserting a hollow airway exchange catheter (jet stylet) prior to tracheal extubation of adult patients with risk factors for difficult tracheal intubation. DESIGN Prospective, 1-year study of 40 consecutive patients undergoing mechanical ventilation who had one or more risk factors for difficult tracheal reintubation. SETTING Surgical ICU of a tertiary university medical center. INTERVENTIONS Study patients at risk for difficult… 

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References

SHOWING 1-10 OF 25 REFERENCES

Incidence and morbidity of extubation failure in surgical intensive care patients.

The incidence, reasons for, and outcome of reintubations in surgical ICU patients varies dramatically depending on the underlying disease process, as well as the predictors of extubation failure detected.

Extubation criteria after weaning from intermittent mandatory ventilation and continuous positive airway pressure

No significant difference between patients successfully extubated and those who required reintubation was found using the traditional weaning criteria or blood gases, and these 3 variables correlated best to the patients' outcome after extubation.

Management of the Difficult Adult Airway With Special Emphasis on Awake Tracheal Intubation

There is much more to learn with regard to recognition of the difficult airway, preparation of the patient for an awake intubation, new techniques of endotracheal intubsation, and establishment of gas exchange in patients who cannot be intubated or ventilated by mask.

Unplanned extubation. Clinical predictors for reintubation.

Unplanned extubation can result in serious complications; however, about half the patients who have UE can be safely observed without immediate reintubation, with outcome of 88 percent of cases being correctly predicted.

Quantification of the Jet Function of a Jet Stylet

These findings validate the term “jet stylet” for all three tube exchangers as even the smallest tube exchanger, coupled with a low lung compliance, can provide a VE consistent with total ventilatorv support for most clinical situations.

Acute complications of endotracheal intubation. Relationship to reintubation, route, urgency, and duration.

There was a 13 percent incidence of acute tracheolaryngeal complications, but no association was found with reintubation, route, urgency, or total duration of endotracheal intubation.

Evaluation of two different extubation criteria: Attributes contributing to success

Conventional respiratory-mechanics extubation criteria may prolong mechanical airway and ventilatory support when used with IMV/CPAP in these patients.

Lung laceration after tracheal extubation over a plastic tube changer.

A case of pneumothorax and lung abscess after extubation of the trachea over a plastic tracheal tube changer (TTC) (JEM 400, TTC; Instrumentation Industries, Bethel Park, Penn.) in which the TTC was advanced until a firm resistance was felt.

A clinical sign to predict difficult tracheal intubation: a prospective study.

A relatively simple grading system which involves preoperative ability to visualize the faucial pillars, soft palate and base of uvula was designed as a means of predicting the degree of difficulty in laryngeal exposure.