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Anaesthesia. 2018 May;73(5):587-593. doi: 10.1111/anae.14244. Epub 2018 Mar 25.

An assessment of the tolerability of the Cook staged extubation wire in patients with known or suspected difficult airways extubated in intensive care.

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Cairns Hospital, Cairns, Qld, Australia.
The Townsville Hospital, Douglas, Qld, Australia.
Sunshine Coast University Hospital, Birtinya, Qld, Australia.
School of Medicine, University of Queensland, St Lucia, Qld, Australia.
School of Medicine, James Cook University, Douglas, Qld, Australia.


The Cook staged extubation set (Cook Medical) has been developed to facilitate management of the difficult airway. A guidewire inserted before tracheal extubation provides access to the subglottic airway should re-intubation be required. This prospective cohort study examines patients' tolerance of the guidewire and its impact on clinical status around tracheal extubation in the intensive care unit. Vital signs, incidence of symptoms and patient tolerance of the wire were recorded. Twenty-three patients were enrolled and 17 (73%) tolerated the wire for 4 h. Nasendoscopy was performed in 11 of these patients and revealed one wire was in the oesophagus. The most common symptom was a mild intermittent cough in 13 patients. There was no impact of the guidewire on nursing care in 16 patients, tolerable impact in five and severe impact necessitating removal of the wire in one patient.


airway assessment: co-existing disease; difficult airway algorithm; management of difficult airway

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