Holiday report! post-op respiratory complications, cuff leaks

Cuff leaks

Many ways to do this and various rules/cut-offs to help determine if it is safe to exubate a patient when there is concern for post-extubation stridor. There are multiple methods to do this:

  • Quantitative:
    • Measure the difference in inspiratory tidal volume (measured with cuff inflated) and the expiratory tidal volume (with cuff deflated, average of lower values over multiple respiratory cycles). This difference is the cuff leak volume, and you can use a cutoff of about 12-14% of the tidal volume or 110mL. If the leak is >10% of the tidal volume or >110mL, there is probably enough cuff leak and it is safe to extubate (with regards to concern for post-extubation stridor)
    • There is also a way to do this by measuring cuff pressures
  • Qualitative: listening for air leak around the endotracheal tube with the cuff deflated

 

Post-procedure respiratory complications

Oxygenation

  • Intrapulmonary shunting: PTX, atelectasis, aspiration
  • Pulmonary edema: cardiogenic, volume in procedure, TRALI
  • Pulmonary embolus

Ventilation

  • Sedatives and other pharmacotherapy effects
  • Airway obstruction
    • Laryngospasm, vocal cord paralysis, airway edema
    • Reactive airway disease/Bronchospasm

 

Evernote: http://www.evernote.com/l/APjTWjeRGAdESaSPQzI88Rkldbo02W19jQc/

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