Inhalation Injury

[IceDoc]

Question: How long do you wait to extubate after an inhalation injury (assuming the patient meets all usual extubation criteria, and there is no other indication for keeping him/her intubated other than a history of smoke inhalation)?

Had a case recently in the unit of a 12yo with smoke inhalation (no burns on body). He met all usual extubation criteria (including a good leak), and was an easy intubation. Upon extubation, he was immediately stridorous. We limped through (actually HE limped through, WE just sweated) with all the usual (epi neb, bipap etc) and all was eventually good. But at the time I certainly was wishing we'd left the tube in.

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[Planktonmd]

Question: How long do you wait to extubate after an inhalation injury (assuming the patient meets all usual extubation criteria, and there is no other indication for keeping him/her intubated other than a history of smoke inhalation)?

Had a case recently in the unit of a 12yo with smoke inhalation (no burns on body). He met all usual extubation criteria (including a good leak), and was an easy intubation. Upon extubation, he was immediately stridorous. We limped through (actually HE limped through, WE just sweated) with all the usual (epi neb, bipap etc) and all was eventually good. But at the time I certainly was wishing we'd left the tube in.

It sounds your patient had Laryngospasm on extubation probably not related to his smoke inhalation.

 

[Mman]

A smoke inhalation injury with no burns? It's my recollection that in burn patients with significant airway injury you leave them tubed for a while (1-2 days) while their upper airway edema sorts itself out. I'm not quite sure about just an inhalational smoke injury that wasn't bad enough to cause any visible burns to the face.

 

[Noyac]

How long after the burn was the extubation?

 

[IceDoc]

It sounds your patient had Laryngospasm on extubation probably not related to his smoke inhalation.

Possibly. A lot of secretions that could have caused laryngospasm were suctioned. However, it didn't have that same squeaky quality I've usually heard. Regardless, the obstruction was clearly glottic or above.

 

[Noyac]

Possibly. A lot of secretions that could have caused laryngospasm were suctioned. However, it didn't have that same squeaky quality I've usually heard. Regardless, the obstruction was clearly glottic or above.

I doubt that the sqeaking would have been present with the edema in the area. I think laryngospasm is highly likely.