PURPOSE: Urgent postoperative re-intubations are often performed by intensivists. A CEC can be left in place after extubation as a possible guide-wire for difficult airways. This may lead to a false sense of security, as unnoticed esophageal dislocations have been described. We evaluated dislocation rates of nasal and oral CECs perioperatively placed in patients with difficult airway. We also evaluated continuous measurement of CO2 as a predictor for dislocation.
METHODS: Over 20 months, all CECs placed at the end of surgery were evaluated. Correct placement was confirmed by nasal fiberoptic. CO2 was then measured continuously until the CEC was removed. Patient tolerance to the CEC was subjectively graded by verbal analog scale (10-point-VAS).
RESULTS: 173 patients (31% females) participated. Mean age was 56±16years, mean weight 74±16kg. Initial intubation was performed fiberoptically awake in 71%, and fiberoptically asleep in 8%. 69% of CECs were placed nasal, 31% oral. 2 CECs were detected to be esophageal when patients arrived at postoperative care. CECs were left in place for 4.4±3.1hours (range 0.5-18hours). In 16% of all CECs, CO2 was not detectible at some point. But only 2 CECs (1 oral, 1 nasal) were then found to be dislocated. When removed, 2 other CECs (1 nasal, 1 oral) were found to be dislocated without having altered the CO2-curve. Overall dislocation rate was 4%. There was no statistical significant difference in dislocation rates nasal vs. oral CEC (p=0.79). Median patient tolerance was 3 (interquartile range 2-5). 8 patients had to be re-intubated; 5 patients were intubated over CEC (successfully); in 3 cases CEC was not chosen as guide.
CONCLUSIONS: Use of CEC is a reliable way of providing fast access to difficult airways. Dislocation rate is low, but fiberoptic evaluation is recommended. CO2 measuring is unreliable.
CLINICAL IMPLICATIONS: Our study shows the high value of a CEC if correct placement can be verified fiberoptically. Patient tolerance is high, dislocation rate is low both nasally and orally, and successful re-intubation rate is high.
DISCLOSURE: The following authors have nothing to disclose: Lorenz Theiler, Marius Wipfli, Robert Greif
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