Following extubation a patient may develop laryngeal edema, which may be severe enough to require reintubation. The severity of the edema can be graded based on the clinical findings.
Categories of laryngeal edema:
Features of major laryngeal edema:
(1) severe respiratory distress
(2) evidence of airway obstruction on laryngoscopy
(3) need for reintubation
• Respiratory distress is characterized by a prolonged inspiratory phase with use of the accessory muscles.
• Direct examination of the airway following extubation is usually avoided if possible because of the risk to the patient.
Features of minor laryngeal edema:
(1) presence of stridor on inspiration (with a high-pitched wheeze)
(2) mild to moderate respiratory distress
(3) need for medical intervention but not reintubation
Features of subclinical laryngeal edema:
(1) absence of significant respiratory distress
(2) no need for clinical intervention
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