Jian-Qiang Dai1,2, Wei-Feng Tu3, Qing-Shui Yin4,5, Hong Xia2, Guo-Dong Zheng2, Liang-da Zhang2, Xian-Hua Huang2. 1. Southern Medical University, Guangzhou, 510515, China. 2. Orthopedic Intensive Care Unit, Guangzhou General Hospital of Guangzhou Military Command, Liuhua Road NO 111, Guangzhou, 510010, China. 3. Department of Anesthesiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China. 4. Southern Medical University, Guangzhou, 510515, China. tcl99@sina.com. 5. Orthopedic Intensive Care Unit, Guangzhou General Hospital of Guangzhou Military Command, Liuhua Road NO 111, Guangzhou, 510010, China. tcl99@sina.com.
Abstract
PURPOSE: This study explored the performance characteristics of a cuff-leak test (CLT) combined with interventional fiberoptic bronchoscopy (FBS) for evaluating whether early nasoendotracheal extubation was possible for patients who had received transoral atlantoaxial reduction plate (TARP) internal fixation surgery. METHODS: 318 patients who underwent surgery were retrospectively analyzed (between January 2006 and December 2012). Extubation was performed by conventional approach (CA group, until December 2008) and improved approach (IA group, from January 2009) including CLT and an interventional FBS procedure. The extubation success within 1-3 days after surgery, incidence of postextubation stridor and tracheal reintubation were examined. RESULTS: More IA-treated patients experienced extubation during the first 2 days than those CA-treated, median extubation time was 3 (2, 3) days in the CA group and 2 (1, 2) days in the IA group (all P < 0.01). The incidence of stridor and reintubation was 5.69 and 0.57 % in IA and 11.98 and 4.93 % in CA, respectively (both P < 0.05). For the CLT-positive patients in the IA group that remained intubated until day 3-4, interventional FBS was applied for safe extubation and achieved 100 % success. CONCLUSION: Early extubation through IA is safe and interventional FBS assists successful extubation for CLT-positive patients who underwent TARP surgery.
PURPOSE: This study explored the performance characteristics of a cuff-leak test (CLT) combined with interventional fiberoptic bronchoscopy (FBS) for evaluating whether early nasoendotracheal extubation was possible for patients who had received transoral atlantoaxial reduction plate (TARP) internal fixation surgery. METHODS: 318 patients who underwent surgery were retrospectively analyzed (between January 2006 and December 2012). Extubation was performed by conventional approach (CA group, until December 2008) and improved approach (IA group, from January 2009) including CLT and an interventional FBS procedure. The extubation success within 1-3 days after surgery, incidence of postextubation stridor and tracheal reintubation were examined. RESULTS: More IA-treated patients experienced extubation during the first 2 days than those CA-treated, median extubation time was 3 (2, 3) days in the CA group and 2 (1, 2) days in the IA group (all P < 0.01). The incidence of stridor and reintubation was 5.69 and 0.57 % in IA and 11.98 and 4.93 % in CA, respectively (both P < 0.05). For the CLT-positive patients in the IA group that remained intubated until day 3-4, interventional FBS was applied for safe extubation and achieved 100 % success. CONCLUSION: Early extubation through IA is safe and interventional FBS assists successful extubation for CLT-positive patients who underwent TARP surgery.
Entities:
Keywords:
Cuff-leak test; Fiberoptic bronchoscopy; Nasoendotracheal extubation; Stridor and tracheal reintubation; TARP
Authors: Bastiaan H J Wittekamp; Walther N K A van Mook; Dave H T Tjan; Jan Harm Zwaveling; Dennis C J J Bergmans Journal: Crit Care Date: 2009-12-01 Impact factor: 9.097