Abstract
We examined the causes of extubation failure in our ICU. Thirty three patients who had been intubated for more than 7 days were prospectively subjected to fiberscopic observation right after extubation to examine the relationship between the findings of the larynx and the intubation period, clinical manifestations, and the outcome of extubation. The clinical symptoms after extubation were classified into upper airway obstruction type and tenacious secretion type. The fiberoptic findings were divided into (1) laryngeal edema, (2) vocal cord injury, and (3) glottic impotency. Results: Average intubation period is 14 days. Patients manifesting airway obstruction have laryngeal edema significantly more than those who are not and reintubation rate is also higher. Non-invasive positive pressure ventilation (NPPV) is effective to some of these obstructed patients. Patients presenting the symptoms of secretion need reintubation or tracheostomy. As is previously reported, repeated intubation may develop laryngeal injury and early tracheostomy is to be appreciated. We could not evaluate the clinical symptoms and fiberoptic findings quantitatively in this study, but we would like to emphasize the importance of differentiating the type of symptoms and laryngeal lesions, and of appropriate treatment for each pathology.
