Extubation of the Challenging or Difficult Airway
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AIRWAY MANAGEMENT (LC BERKOW, SECTION EDITOR)
Extubation of the Challenging or Difficult Airway Matteo Parotto 1,2,3
&
Richard M. Cooper 1 & Elizabeth C. Behringer 4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This review explores relevant definitions, epidemiology, management, and potential future research directions in the extubation of the challenging/difficult airway. It provides guidance on identifying patients at risk and how to approach these clinical scenarios. Recent Findings Based on recent literature, including large-scale audits and closed claims analysis, it is increasingly recognized that extubation of the difficult airway is a situation at risk of severe adverse events. Some strategies to manage the extubation of the challenging/difficult airway have been described. Summary Extubating the challenging/difficult airway is a high-risk situation. However, it is fundamental to keep in mind that intended extubation is always an elective procedure. As such, it is imperative to adhere to principles of careful patient and context assessment, planning, and execution only when optimal conditions have been secured. Keywords Endotracheal intubation . Extubation . Airway management . Airway exchange catheter . Supraglottic airway
Introduction Extubation is an essential procedure in anesthesia, when endotracheal intubation is required, as well as in critical care medicine, when mechanical ventilatory support is needed. While safely performed in a large proportion of cases, it can present significant challenges and complications. Complications associated with extubation can be severe,
resulting in major morbidity and mortality [1]. In this review, we explore relevant definitions, epidemiology, and management of extubation as well as future research opportunities. We will not focus on the management of low-risk extubations; however, many of the principles outlined here may apply to those circumstances as well. Of note, extubation is considered an aerosol-generating medical procedure (AGMP) [2], and according to the specific
Literature search strategy: a search of MEDLINE, CINAHL, Embase, Web of Science, and CENTRAL for published English-language relevant papers was conducted. The search was run periodically, last on May 23, 2020. The terms included “extubation,” “endotracheal extubation,” “difficult extubation,” and “challenging extubation.” The references of retrieved and selected articles were reviewed to identify additional potentially relevant sources. This article is part of the Topical Collection on Airway Management * Matteo Parotto [email protected] Richard M. Cooper [email protected]
2
Department of Anesthesia and Pain Management, Toronto General Hospital, EN 429 - 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
3
Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
4
Division of CardioVascular Surgery and Critical Care, Kaiser Permanente Los Angeles Medical Center, 1526 N Edgemont, Lo
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