Intubating patients with laryngeal edema

[leviathan]

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I had a difficult intubation recently due to laryngeal edema; it was challenging to get adequate volumes with bag mask ventilation, and challenging to pass the tube due to severe edema of the cords (had to end up using a 6.0 ETT). Any suggestions on the best way to approach intubating these patients?

 

[nimbus]

I had a difficult intubation recently due to laryngeal edema; it was challenging to get adequate volumes with bag mask ventilation, and challenging to pass the tube due to severe edema of the cords (had to end up using a 6.0 ETT). Any suggestions on the best way to approach intubating these patients?

What you did. Use a smaller tube. Use a little lube. Make sure your trajectory is good. And muscle it in with a twist if necessary.

 

[coffeebythelake]

I had a difficult intubation recently due to laryngeal edema; it was challenging to get adequate volumes with bag mask ventilation, and challenging to pass the tube due to severe edema of the cords (had to end up using a 6.0 ETT). Any suggestions on the best way to approach intubating these patients?

Why did they have laryngeal edema, did u recognize this as a possibility before inducing GA?

 

[drmwvr]

eschmann and a little muscle...

 

[markneil]

I had a difficult intubation recently due to laryngeal edema; it was challenging to get adequate volumes with bag mask ventilation, and challenging to pass the tube due to severe edema of the cords (had to end up using a 6.0 ETT). Any suggestions on the best way to approach intubating these patients?

Yes, was it suspected before induction? Maybe some racemic epi/IV steroids beforehand if suspected. We have a FO nasopharyngoscope handy in our OR for the ENT guys that we can use so a little lidocaine spray and versed to take a look at the severity. Have several tubes with differing sizes handy as well as a glidescope.

 

[GassYous]

awake trach

 

[Arch Guillotti]

awake trach

ECMO for sure.

 

[leviathan]

Why did they have laryngeal edema, did u recognize this as a possibility before inducing GA?

ICU patient, self-extubated and she had significant stridor and respiratory failure, failed steroids + epi etc.

No predictors of difficult airway or difficult mask ventilation (and outside of the edema she wouldn't be), so I just did a standard RSI. Sats were high 90s beforehand. Despite a good seal with the BVM and chest rise the sats dropped afterwards into low 80s and we were not able to get them higher before trying. Easy laryngoscopy but very edematous cords and even a 6.5 would not pass. I could have tried to muscle in a 6.5 but the sats were so low I felt I had no time to play around before bagging the sats back up. Ultimately got the tube in but wondered if I could have done anything better or differently. I'm not sure if I was having trouble ventilating/oxygenating because of the partial airway obstruction, or if she was just getting worse from negative pressure pulmonary edema / issues further downstream.

 

[narcusprince]

Bougie to intubate. You can always size up and down with a bougie. Otherwise if you have recognized the airway as difficult do an afoi.

 

[Arch Guillotti]

This is all you need to know from the zipster:

Last day of residency was ,without a doubt, one of the best days of my life... I was on call, 3AM get a call from burn unit to emergently intubate a big guy that had been 50% burned upper torso with smoke inhalation. Half a stick of STP and 100 o' sux-- all edema. I told myself I wasn't goin' out like this. Just rammed a 7.5 where I thought it should be and it slid in. BS bilateral and PCXR was solid. O2 sats golden and RT lady all happy. No procedure note, no charge sheet. Beeper left at OR board when no one was lookin'. Slid out hospital at 0645 with no goodby's, thank you's or gonna miss you's. Got to the apt. and loaded up U-Haul with 100% VA disability, 100% SS disability uncle( Vietnam, agent orange, PTSD--you know the bogus gig). Letter and keys in an envelope dropped in the apt. night box. No change or forwarding of address with post office, no cares about apt. or electric deposits. ZIPPY DONE EVAPORATED! Roll on out at 1700 with floorboard boom box playin' "Comfortably Numb", and a bottle of chilled Wild Turkey in the ice chest. Uncle drivin' and on outskirts of town we light up a big fat doober. I told him not to shut off the old biitch until we were home. Ole Hunter Thompson didn't have a thing on us that night... Regards, ---Zip

 

[nimbus]

This is all you need to know from the zipster:

That post is so old they were giving sodium thiopental.

 

[NVO]

That post is so old they were giving sodium thiopental.

and sux for burn pts 😦(of course idk the timeframe)

 

[nimbus]

and sux for burn pts 😦(of course idk the timeframe)

The way it reads to me, it sounded like a fresh burn.

 

[coffeebythelake]

This is all you need to know from the zipster:

 

[anbuitachi]

I had a difficult intubation recently due to laryngeal edema; it was challenging to get adequate volumes with bag mask ventilation, and challenging to pass the tube due to severe edema of the cords (had to end up using a 6.0 ETT). Any suggestions on the best way to approach intubating these patients?

1) smaller tube
2) bougie
3) jam harder. dont tell me you dont have the muscle strength to get thru some edema???

 

[Mofeen]

This is all you need to know from the zipster:

What happened to him? He was so hilarious!

 

[Arch Guillotti]

I had a difficult intubation recently due to laryngeal edema; it was challenging to get adequate volumes with bag mask ventilation, and challenging to pass the tube due to severe edema of the cords (had to end up using a 6.0 ETT). Any suggestions on the best way to approach intubating these patients?

Always have a bougie available. Downsize the tube as you did and if there is difficulty passing it then corkscrew it over the bougie. I am also a fan of the rigid malleable bougies.

 

[2Fast2Des]

What happened to him? He was so hilarious!

Some say he's still lighting up a big fat doober