Airway Management of “At-Risk Extubation'” in Intensive Care

Extubation failure due to airway problems is rare in critically ill patients. Intensive care mortality and morbidity among patients having extubation failure due to airway problems are less than among those requiring re-intubation due to respiratory failure. This is due to the fact that the latter group of patients is mostly comprised of postoperative patients. Postoperative extubation failure may arise because of many possible mechanical problems due to the patient, surgery or anesthesia. Problems which cause the obstruction of upper airways may not give symptoms until tracheal extubation is performed. Obesity, obstructive sleep apnea syndrome, major head and neck surgery, upper airway surgery and cervical column operations are hazardous conditions affecting extubation success. Upper airway obstructing conditions like edema, soft tissue collapse and laryngospasm are frequently observed in this group of patients and because of these conditions, it may become hard to ensure airway integrity after extubation. For this reason, it is necessary to identify the postoperative patients who are expected to have difficult extubation processes and to transfer them to intensive care unit for a careful and planned extubation process. In this review, an efficient strategy for a successful extubation will be explained for patients having high risks for extubation failure and difficult airway problems.