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A5277 - Successful Application of Non-Invasive Positive Pressure Ventilation for Critically Ill Patients in Respiratory Failure with Postextubation Stridor
Author Block: J. Cho, M. Kim, M. Park, J. Kim; Inha University Hospital, Incheon, Korea, Republic of.
Postextubation stridor (PES) is a common complication of intubation and caused by injury of larynx. A decreased size of laryngeal lumen by mucosal edema may present as stridor or respiratory distress. Female gender, larger endotracheal tube, longer duration of intubation, higher cuff pressure, and difficult intubation are known as risk factors for PES. The combination of inhaled epinephrine and intravenous corticosteroids is a treatment for PES. However, the efficacy of non-invasive positive pressure ventilation (NIPPV) is not reported. The first patients was a 62 years old man with heart failure. After a surgery of cataract, he got a respiratory distress, hypercapnia and pulmonary congestion. We applied mechanical ventilation (MV) with endotracheal tube for consecutive three days. He recovered from respiratory failure with the diuretics. Endotracheal tube was decided to remove. On cuff leak test (CLT), leaking volume was over 130 ml. After 15 minutes later of extubation, high pitched stridor was heard and severe dyspnea was complained. Inhaled epinephrine and intravenous dexamethasone was administrated but symptoms were not improved. Non-invasive positive pressure ventilation with helmet was applied. The patients became stable about ten minutes later. NIPPV continued for 18 hours, and then completely weaned. The second patient was 40 years old pregnant woman with pre-eclampsia. Massive bleeding after delivery resulted in disseminated intravascular coagulation and a large amounts of transfusion was needed. MV with endotracheal tube was applied for transfusion related lung injury. After four days of endotracheal intubation, the patients was markedly improved, and endotracheal tube was removed. Leaking volume by CLT was 120 ml. As soon as extubation, Stridor was heard and she complained dyspnea. NIPPV with facial mask was applied, and inhaled epinephrine and intravenous dexamethasone was administrated. After three days later, NIPPV could be weaned. Finally, a third patient, 67 years old woman was admitted by liver abscess septic shock and acute respiratory distress syndrome. Before weaning of MV, leaking volume on CLT was 130 ml. Stridor was heard after extubation. As she did not complain dyspnea, inhaled epinephrine and intravenous dexamethasone was preferentially administrated however it was not effective. Stridor was disappeared after applying of NIPPV with helmet for 16 hours. NIPPV could be considered as an alternative for treatment of postextubation stridor.