Postintubation Laryngeal Edema

Question 1

Risk factors for postintubation laryngeal edema

Answer 1

Age <4 years
ETT that is too large (most common cause)
ETT cuff volume too high
Rigid bronchoscopy
Multiple/ traumatic/ prolonged intubation
Coughing
Head or neck surgery
Head repositioning during surgery
Hx of infectious or post-intubation croup
Trisomy 21
URI (?)

Question 2

Tracheal mucosa perfusion pressure

Answer 2

25 cm H2O

Question 3

Postintubation laryngeal edema presentation

Answer 3

Hoarseness
Barky cough
Stridor

Within 30-60 minutes of extubation

Question 4

Postintubation laryngeal edema prevention

Answer 4

Maintain air leak <25 cm H2O
Use manometer to measure cuff pressure intermittently

Question 5

Postintubation laryngeal edema first-line tx

Answer 5

Racemic epinephrine delivered by intermittent PPV, via facemask, or via nebulization

Question 6

Racemic epinephrine 2.25% dose 0-20kg child

Answer 6

0.25mL epi solution in 2.5mL NS

Question 7

Racemic epinephrine 2.25% dose 20-40kg child

Answer 7

0.5mL epi solution i 2.5mL NS

Question 8

Racemic epinephrine 2.25% dose >40kg child

Answer 8

.075mL epi solution in 2.5mL NS

Question 9

Postintubation laryngeal edema secondary tx

Answer 9

Cool humidified O2
Dexamethasone 0.25-0.5mg/kg IV (max effect in 4-6 hours)
Heliox

Question 10

Racemic epinephrine special consideration for administering

Answer 10

Pt should be observed for a minimum of four hours after admin