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Crit Care. 2015 Sep 23;19:295. doi: 10.1186/s13054-015-1018-2.

Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review.

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Department of Anesthesiology, Zuyderland Medical Centre, Henri Dunantstraat 5, Postbus 4446, 6401 CX, Heerlen, The Netherlands.
Department of Intensive Care Medicine, Maastricht University Medical Centre, P. Debyelaan 25, Postbus 5600, 6202, AZ, Maastricht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Heidelberglaan 100, Postbus 85500, 3584, CX, Utrecht, The Netherlands.


Endotracheal intubation is frequently complicated by laryngeal edema, which may present as postextubation stridor or respiratory difficulty or both. Ultimately, postextubation laryngeal edema may result in respiratory failure with subsequent reintubation. Risk factors for postextubation laryngeal edema include female gender, large tube size, and prolonged intubation. Although patients at low risk for postextubation respiratory insufficiency due to laryngeal edema can be identified by the cuff leak test or laryngeal ultrasound, no reliable test for the identification of high-risk patients is currently available. If applied in a timely manner, intravenous or nebulized corticosteroids can prevent postextubation laryngeal edema; however, the inability to identify high-risk patients prevents the targeted pretreatment of these patients. Therefore, the decision to start corticosteroids should be made on an individual basis and on the basis of the outcome of the cuff leak test and additional risk factors. The preferential treatment of postextubation laryngeal edema consists of intravenous or nebulized corticosteroids combined with nebulized epinephrine, although no data on the optimal treatment algorithm are available. In the presence of respiratory failure, reintubation should be performed without delay. Application of noninvasive ventilation or inhalation of a helium/oxygen mixture is not indicated since it does not improve outcome and increases the delay to intubation.

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