Articles: laryngeal-edema-etiology.
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Postextubation problems such as laryngeal edema and reintubation are common complications after tracheal intubation. The cuff-leak test has been proposed as a method of identifying those patients at high risk in clinical practice, but its efficacy remains controversial. ⋯ Our results suggest the cuff-leak test accurately predicts which adult patients are at high risk of postextubation airway complications, but randomized controlled trials are needed to further assess this diagnostic strategy.
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Laryngeal edema is a frequent complication of intubation. It often presents shortly after extubation as post-extubation stridor and results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischemia resulting in an inflammatory response. ⋯ The use of non-invasive positive pressure ventilation is not indicated since this will delay reintubation. Reintubation should be considered early after onset of laryngeal edema to adequately secure an airway. Reintubation leads to increased cost, morbidity and mortality.
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To evaluate the efficacy and safety of prophylactic corticosteroid therapy in preventing postextubation laryngeal edema (PELE) and the need for reintubation in adults. ⋯ Data from the most recent well-designed clinical trials suggest that prophylactic corticosteroid therapy can reduce the incidence of PELE and the subsequent need for reintubation in mechanically ventilated patients at high-risk for PELE. Based on this information, clinicians should consider initiating prophylactic corticosteroid therapy in this population. Further studies are needed to establish the optimal dosing regimens as well as the subgroups of patients at high risk for PELE who will derive the greatest benefit from this preventive steroid therapy.
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Review Case Reports
Acute airway compromise after brief exposure to a Dieffenbachia plant.
Dieffenbachia is a common domestic plant. Oral contact with the plant usually is associated with minimal consequences. However, chewing on the stem or the leaf of the Dieffenbachia can result in painful oropharyngeal edema and the inability to speak or handle secretions. ⋯ The exact mechanism of edema is not known; therefore, methods of treatment are variable. We recommend caution when presented with a patient exposed to Dieffenbachia. Even the patient who initially seems stable may have an airway that will quickly deteriorate.