med 610 clinical respiratory diseases & critcare med

Mechanical Ventilation

Case 9

A 30 year-old woman has been intubated for 2 days following a motor vehicle accident. On morning rounds, she passed her spontaneous breathing trial and a decision was made to extubate her. The respiratory therapist removes the endotracheal tube and shortly afterwards, she is noted to have stridor. You are called to the room and find her struggling to breathe. She has audible stridor and suprasternal retractions on exam. Her oxygen saturation on 4L oxygen by nasal cannula is 94%.

What is the differential diagnosis for her problem?


How should you manage the patient? Does she need to be reintubated?


In cases where you suspect prior to extubation that a patient may have laryngeal edema and post-extubation stridor, what can you do to minimize the risk of this problem?


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