Airway risk factors CC

Question 1

Risk factors for endotracheal tube-related tracheoesophageal fistula

Answer 1

• Prolonged intubation
• Diabetes
• Overinflation of the endotracheal cuff
• Hypotension leading to necrosis of the tracheal wall
• Recurrent airway infections

Question 2

Risk factors for MV liberation failure

Answer 2

• Age > 65 years
• Chronic cardiorespiratory disease (including COPD and heart failure/LV dysfunction)
• Obstructive Sleep Apnea (OSA) / Obesity
• PaCO2 > 45 mmHg after extubation or > 6.5 kPa
• Neuromuscular disorders
• Positive fluid balance
• Ventilation duration > 6 days
• Failure of more than one spontaneous breathing trial (SBT)
• Presence of >1 comorbidity
• Weak cough reflex
• Upper airway stridor at extubation
• APACHE II score > 12 on the day of extubation
• Admission to a medical, pediatric, or multispecialty intensive care unit (ICU)
• Pneumonia as the etiology of respiratory failure

Question 3

Risk factors for laryngeal edema related to intubation

Answer 3

• Traumatic intubation
• Intubation > 6 days
• Large endotracheal tube
• Those who have been repeatedly reintubated and extubated
• Women

Question 4

Risk factors for post extubation stridor

Answer 4

Patient risk factors:

• Female
• Muscle weakness
• Tracheal infection
• Tracheal stenosis
• Recent airway related surgery

Intensive care related risk factors:

• Intubation >36 hours
• Excessive cuff pressures
• Large ETT
• Aggressive suctioning
• Nasogastric tube insertion

Question 5

Independent risk factors for difficult mask ventilation

Answer 5

• Presence of a beard
• Body mass index >26 kg/m²
• Lack of teeth
• Age >55
• H/o snoring

Question 6

Risk factor for tracheal anastomosis complications post tracheal resection

Answer 6

• reoperation,
• diabetes,
• tracheal resection ≥4 cm,
• laryngotracheal resection,
• age <18

Note: neither obesity (BMI >35) nor steroid use are risk factors

Question 7

Factors associated with successful use of NIPPV in the acute setting

Answer 7

• synchronous breathing with the ventilator,
• less air leak,
• fewer secretions,
• respiratory rate less than 30/ min,
• lower APACHE II score (< 29),
• pH greater than 7.30,
• GCS of 15,
• Pao2 /Fio2 greater than 146 after the first hour,
• COPD, and cardiogenic pulmonary edema

MCQs