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At least 19 recordsLinked to original sources
PubMed2002

The cuff leak test to predict failure of tracheal extubation for laryngeal edema.

OBJECTIVE: Laryngeal edema secondary to endotracheal intubation may require early re-intubation. Prior to extubation the absence of leak around an endotracheal tube may predict laryngeal edema after extubation. We evaluated the usefulness of a quantitative assessment of such a leak to identify the patients who will require early re-intubation for laryngeal edema. METHODS: This prospective study included 76 patients with endotracheal intubation for more than 12 h. The leak, in percent, was defined as the difference between expired tidal volume measured just before extubation, in volume-controlled mode, with the cuff inflated and then deflated. The best cut-off value to predict the need for re-intubation for significant laryngeal edema was determined and the patients were divided into two groups, according to this cut-off value. RESULTS: Eight of the 76 patients (11%) needed re-intubation for laryngeal edema. Patients requiring re-intubation had a smaller leak than the other patients [9 (3-18) vs 35 (13-53)%, p<0.01]. The best cut-off value for gas leak was 15.5%. The high leak group included 51 patients, of whom only two patients (3%) required re-intubation. The low leak group included 25 patients, among whom six patients (24%) required re-intubation ( p<0.01). The sensitivity of this test was 75%, the specificity 72.1%, the positive predictive value 25%, the negative predictive value 96.1% and the percent of correct classification 72.4%. CONCLUSIONS: A gas leak around the endotracheal tube greater than 15.5% can be used as a screening test to limit the risk of re-intubation for laryngeal edema.

Aged↗
PubMed1995

Direct laryngoscopy with provocation: a useful method to distinguish acute laryngeal edema from nonorganic disease.

BACKGROUND: Acute laryngeal edema is a manifestation of anaphylaxis, is frequently sudden in onset and requires immediate treatment to prevent further airway compromise. Nonorganic disease such as globus hystericus may present with symptoms similar to acute laryngeal edema. Distinguishing life-threatening acute laryngeal edema from non-life-threatening disease may be difficult. OBJECTIVE: We present a patient in which direct laryngoscopy was used to distinguish acute laryngeal edema from nonorganic disease. METHODS: A case report of a woman who had presented to numerous emergency rooms with symptoms of cough, sensation of throat closing, and hoarseness when exposed to odors such as nail polish remover and musk cologne. She was treated repeatedly with subcutaneous epinephrine, oral diphenhydramine and intravenous methylprednisolone. Her history was not classic for IgE-mediated anaphylaxis and we challenged her with nail polish remover while visualizing her vocal cords with direct laryngoscopy. RESULTS: Upon challenge with an offending agent, her symptoms were again suggestive of life-threatening laryngeal edema. Direct laryngoscopy, however, revealed no objective evidence of airway obstruction. CONCLUSION: Direct laryngoscopy with provocation is useful in distinguishing acute laryngeal edema from nonorganic disease.

Bronchial Provocation Tests↗
PubMed1995

Incidence and predictors of postextubation laryngeal edema in pediatric patients with congenital heart disease.

Laryngeal edema developed in 10.1% of studied patients with congenital heart disease after cardiac surgery. The 181 patients were divided into two groups; those with laryngeal edema (group 1) and those without laryngeal edema (group 2). The mean ages in group 1 and 2 were 10 and 22.9 months. Group 1 patients were younger on average than those of group 2 (p < 0.05). The differences in the cardiopulmonary bypass time and anesthesia time between the two groups were not statistically significant. The duration of intubations and ventilatory support before and after the onset of laryngeal edema and the period of the ICU stay were longer in group 1 than in group 2 (P < 0.05). A predictor of postextubation laryngeal edema was not found in our patients from above mentioned parameters. We conclude that the higher incidence of laryngeal edema may be due to young age (most were under 1 year of age), and duration of intubation and ventilatory support.

Adolescent↗
PubMed2003

Laryngeal edema: perioperative nursing considerations.

Laryngeal edema is a relatively rare yet serious postoperative complication for those patients undergoing general anesthesia. Maintenance of airway and breathing are always the first priority of perioperative patient care. Medical-surgical nurses working in postoperative settings must be familiar with the signs, symptoms, and necessary prompt treatment for this life-threatening condition.

Adult↗
PubMed1982

The significance of laryngeal edema following radiotherapy of carcinoma of the vocal cord.

Laryngeal edema persisting for more than three months following radiotherapy developed in 38 of 247 (15.4%) patients irradiated for carcinoma of the vocal cord. In 17 (44.7%) of these patients, the laryngeal edema was associated with persistent or recurrent disease, although only 25.4% of the patients with uncontrolled disease had laryngeal edema. The incidence of laryngeal edema was 13.1% for T1 disease, 23.8% for T2, and 21.4% for T3 and T4 disease. It increased significantly with increase of minimum tumor dose greater than or equal to 7000 rads or with NSD greater than 1900 ret, being 46.2% with minimum tumor dose greater than or equal to 7000 rad and 13.7% with minimum tumor dose less than 7000 rad and 43% with NSD greater than 1900 ret and 17% with NSD less than or equal to 1900 ret. It also increased with increase of field size, being 13.4% with field sizes less than 6.0 x 6.0 cm2, and 24.4% with field sizes greater than or equal to 6.0 x 6.0 cm2. When laryngeal edema is progressive and unresponsive to conservative measures, multiple biopsies should be performed to establish the presence of persistent or recurrent disease before salvage surgery is attempted. However, if it is mild, stable, no visible recurrence develops, and especially if it is limited to the arytenoids, no biopsy should be attempted because of the risk of inducing laryngeal necrosis.

Adult↗
PubMed2003

Laryngeal edema and death from asphyxiation after tooth extraction in four patients with hereditary angioedema.

BACKGROUND: Recurrent angioedema is the hallmark of various inherited or acquired angioedema diseases. Hereditary angioedema, or HAE, due to C1 inhibitor, or C1NH, deficiency has considerable implications for dental health care providers because dental surgery may trigger distressing and even life-threatening episodes. CASE DESCRIPTION: The authors reviewed the literature, focusing on the pathogenesis, clinical signs and treatment of HAE. They also provided case reports of four patients who died from laryngeal edema induced by tooth extraction. In patients with HAE, dental surgery--including tooth extraction--may be followed by self-limiting edema episodes, including lip swelling, facial swelling, tongue edema and laryngeal edema with upper airway obstruction. Preoperative prophylaxis has been performed with attenuated androgens, fresh frozen plasma, C1NH concentrate and antifibrinolytics. The four patients described underwent tooth extraction, which, after a symptom-free latency of four to 30 hours, provoked laryngeal edema. Three of the patients died of asphyxiation the night after surgery, and the fourth died on the second night. In three of the patients, laryngeal edema had not occurred previously. CLINICAL IMPLICATIONS: Before undergoing dental surgery, patients with a history of recurrent angioedema should be evaluated for C1NH deficiency. If it is present, they are at risk of developing life-threatening laryngeal edema.

Adult↗
PubMed2006

Laryngeal edema associated with the ProSeal laryngeal mask airway in upper respiratory tract infection.

PURPOSE: We report an unusual case of vocal cord edema associated with the use of a ProSeal laryngeal mask airway (PLMA) in an adult patient with an undiagnosed upper respiratory tract infection (URTI). CLINICAL FEATURES: A 55-yr-old woman had fixation of a radial fracture under general anesthesia with muscle relaxation. She developed audible wheezing 30 min after PLMA insertion. Bronchoscopic examination revealed significant vocal cord edema. Adequate ventilation was possible at increased airway pressures, and the administration of dexamethasone 4 mg iv produced clinical resolution of the stridor and airway obstruction. The patient admitted to having mild symptoms of an URTI on postoperative questioning. CONCLUSION: Airway hyperreactivity secondary to the URTI is the most likely etiological factor; other possibilities include trauma from insertion and chemical irritation. Although pediatric studies suggest that the LMA-Classic carries less risk than endotracheal intubation in the presence of URTI, this case report demonstrates that caution is still warranted when using supraglottic airways. The PLMA permitted effective ventilation despite increased airway resistance; nevertheless its role in patients with URTI is unclear. It is possible that the bulkier cuff design of the PLMA, compared to that of the LMA-Classic, may have partly contributed to the development of edema in this setting.

Anti-Inflammatory Agents↗
PubMed2000

Asphyxiation by laryngeal edema in patients with hereditary angioedema.

OBJECTIVE: To describe the occurrence of fatal laryngeal edema in patients with hereditary angioedema due to C1 esterase inhibitor deficiency. PATIENTS AND METHODS: We describe 6 patients from various regions of Germany who died from laryngeal edema within the last 10 years. Furthermore, we conducted a retrospective survey of 58 patients with hereditary angioedema, originating from 46 affected families. The data were obtained from the attending physicians and from the patients' relatives. RESULTS: Among the 6 reported patients, aged 9 to 78 years, hereditary angioedema had been diagnosed in 3 and was undiagnosed in 3. None of them had an emergency cricothyrotomy or received C1 inhibitor concentrate. The interval between onset of the laryngeal edema and asphyxiation was 20 minutes in a 9-year-old boy, and in the other patients, the interval was 1 to 14 hours (mean for all, 7 hours). The retrospective survey of 58 patients with hereditary angioedema revealed 23 deaths by asphyxiation (40%). The average age of all 29 patients at the time of asphyxiation was 39 years. CONCLUSION: Laryngeal edema in hereditary angioedema may be fatal. Most of the patients asphyxiated between their 20th and 50th years of life, but asphyxiation can occur even in children. The possibility that the first episode of laryngeal edema may be fatal must be emphasized to the relatives, and attending physicians must have a high degree of awareness.

Adolescent↗
PubMed2006

The cuff-leak test is a simple tool to verify severe laryngeal edema in patients undergoing long-term mechanical ventilation.

OBJECTIVE: The cuff-leak test has been proposed as a simple tool to clinically predict stridor or respiratory distress secondary to laryngeal edema following extubation. However, the true incidence of laryngeal edema in patients on long-term mechanical ventilation is uncertain. The relationship between upper airway obstruction (detected by video bronchoscopy) and the cuff-leak test value for patients with prolonged translaryngeal intubation during percutaneous dilatational tracheostomy (PDT) was investigated. DESIGN: Prospective, clinical investigation. SETTING: Intensive care unit of a university hospital. PATIENTS: Ninety-five patients with prolonged translaryngeal intubation requiring PDT were enrolled during a 12-month period. INTERVENTIONS: Cuff-leak test, PDT, video bronchoscopy. MEASUREMENTS AND MAIN RESULTS: The average duration of translaryngeal intubation was 28.1 +/- 17.6 days. The incidence of severe laryngeal edema was 36.8% (35/95). We chose 140 mL as the threshold cuff-leak volume below which edema is indicated. The rate of cuff-leak test positivity was 38.9% (37/95). The sensitivity and the specificity of the test were 88.6% and 90.0%, respectively. The positive and negative predictive values were 83.8% and 93.1%, respectively. Patients who developed severe laryngeal edema had a smaller leak volume than those who did not, expressed in absolute values (53.9 +/- 56.2 vs. 287.9 +/- 120.0 mL; p < .001) or in relative values (10.1 +/- 10.2 vs. 55.3 +/- 22.7%, p < .001). The occurrence of severe laryngeal edema was not associated with age, gender, body weight, respiratory failure due to pneumonia, duration of translaryngeal intubation, endotracheal tube diameter, Acute Physiology and Chronic Health Evaluation II score, or history of self-extubation. CONCLUSIONS: A reduced cuff-leak volume measured before PDT may signal the presence of severe laryngeal edema in patients on long-term mechanical ventilation.

APACHE↗
PubMed1998

[Chronic laryngeal edema as a late reaction to radiochemotherapy].

In addition to mucositis and myelotoxicity as well known early reactions after radiotherapy or radiochemotherapy in advanced head and neck tumors, late toxicity following treatment is an often underestimated problem. Between 1992 and 1995, 68 patients with advanced oro- and hypopharyngeal tumors were treated primarily with accelerated concomitant boost radiochemotherapy (total dose irradiations of 66 Gy and carboplatin as chemotherapy). Ninety-three per cent of the patients had stage IV disease according to the UICC-TNM classification. Monitoring of follow-up included late toxicity with special attention given to laryngeal edema. In 37 patients (54%) edema of the larynx as a late complication of radiochemotherapy was observed by clinical investigation and CT scan. The median onset of laryngeal edema was found 121 days after completion of therapy, with a median time of observation of 250 days. Observations in these patients demonstrated the chronic character of this edema. An increase in the laryngeal edema in 5 cases resulted in tracheostomy. Laryngeal edema in 10 patients was associated with recurrence of tumor. These results show that after xerostomia laryngeal edema is the main late toxicity in the head and neck after radiochemotherapy and should lead to further investigations to exclude possible recurrent tumor.

Adult↗
PubMed2001

Treatment of 193 episodes of laryngeal edema with C1 inhibitor concentrate in patients with hereditary angioedema.

BACKGROUND: Hereditary angioedema (HAE) is an autosomal dominant disease (Mendelian Inheritance in Man 106100) caused by an inherited deficiency of C1 inhibitor (C1-INH) function. The clinical symptoms include skin swelling, abdominal pain, and life-threatening episodes of upper airway obstruction. We evaluated the efficacy of C1-INH concentrate for treating sudden airway compromise. METHODS: A series of 95 patients with HAE and a functional deficiency of C1-INH belonging to 59 families underwent screening for laryngeal edema. Double-blind treatment of randomized patients was not justifiable because of the life-threatening nature of this condition. Efficacy was evaluated by determining the interval from injection of C1-INH concentrate to the beginning of resolution of symptoms. The mean duration of episodes of laryngeal edema was compared in treated and untreated patients. Clinical information was obtained from emergency department physicians, the hospitals involved, reports of the general practitioners, and patients and their relatives. RESULTS: Forty-two patients had 517 episodes of laryngeal edema. Eighteen patients received 500- or 1000-U injections of C1-INH concentrate in 193 episodes. The C1-INH concentrate was effective in all laryngeal edemas. The interval from injection to interruption in progress of symptoms ranged from 10 minutes to 4 hours (mean +/- SD, 42.2 +/- 19.9 minutes). The mean +/- SD duration of laryngeal edema was 15.3 +/- 9.3 hours in patients who received C1-INH concentrate and 100.8 +/- 26.2 hours in those who did not. CONCLUSIONS: Injected C1-INH concentrate is highly and rapidly effective in the treatment of laryngeal edema of HAE. Relief and resolution of symptoms begins 30 to 60 minutes after injection, and duration of the upper airway obstruction is substantially reduced.

Adult↗
PubMed1983

Laryngeal edema as a complication of chemical peel.

Laryngeal edema is a rare complication in patients undergoing chemical face peels. Symptoms of stridor, hoarseness, and tachypnea developed within 24 hours after peeling and subsided within another 24 hours after inhalation therapy with heated aerosol mist was begun. All patients who developed this complication were heavy smokers. A possible mechanism by which this complication was produced is discussed and experience with a drug regimen to prevent its occurrence is presented.

Chemexfoliation↗
PubMed2001

[Severe laryngeal edema after tracheal extubation--report of a case].

An 80-year old female underwent subtotal esophagectomy with neck lymphnode dissection for esophageal cancer. The tracheal intubation was done repeatedly. Anesthesia was maintained with O2-N2O-isoflurane. No complications were observed during the operation. About thirty minutes after tracheal extubation, she developed airway obstruction with tracheal tug and stridor. Severe laryngeal edema was found by bronchofiberscopy. Percutaneous minitracheostomy was performed under ventilation support by laryngeal mask airway. Seven days later, bronchoscopy examination revealed that the laryngeal edema had disappeared. It should be kept in mind that severe laryngeal edema could develop immediately after extubation.

Aged↗
PubMed1994

Racemic versus l-epinephrine aerosol in the treatment of postextubation laryngeal edema: results from a prospective, randomized, double-blind study.

OBJECTIVE: To determine whether any advantage exists using racemic epinephrine instead of the more potent and less expensive levo(1)-epinephrine in the treatment of postextubation laryngeal edema. DESIGN: Prospective, double-blind, randomized study. SETTING: Pediatric intensive care unit in a university teaching hospital. PATIENTS: Twenty-eight patients with stridor during the immediate postextubation period. INTERVENTIONS: After extubation, patients demonstrating clinically important stridor were randomized in a double-blind fashion to receive an aerosol containing either 2.25% racemic or 1% l-epinephrine. MEASUREMENTS AND MAIN RESULTS: Heart rate, respiratory rate, blood pressure, and stridor score were determined at 20, 40, and 60 mins and 4 and 8 hrs after the initial aerosol administration. Patients in both groups demonstrated significant (p < .01) reductions in stridor score after aerosol administration. No significant differences were observed between treatment groups in improvement in stridor score or the number of subsequent aerosols required. Respiratory rate decreased significantly 40 and 60 mins after l-epinephrine but not after racemic epinephrine. No significant change in heart rate or blood pressure occurred after aerosol administration in either group. CONCLUSIONS: These data suggest that aerosolized l-epinephrine is as effective as aerosolized racemic epinephrine in the treatment of postextubation laryngeal edema without additional adverse side effects. When dosed appropriately, l-epinephrine is a less expensive and more widely available alternative to racemic epinephrine for the treatment of postextubation laryngeal edema.

Aerosols↗
PubMed2004

[A case report of severe laryngeal edema which occured before removal of a laryngeal mask airway].

A 41-year-old woman was scheduled for a partial hip arthroplasty. She was suffering from malignant rheumatoid arthritis for a long time and we recognized her difficult airway. After epidural catheterization, anesthesia was induced with fentanyl, thiopental, and 5% sevoflurane with oxygen. A laryngeal mask airway (LMA ; size 3) was inserted smoothly on third trial after suxamethonium chloride administration. Anesthesia was maintained with fentanyl, vecuronium bromide, sevoflurane with oxygen and epidural anesthesia. No complications were observed during the operation. After reversal of muscle relaxant, spontaneous respiration returned. But inspiratory stridor and chest wall retraction occurred soon, and we found severe epiglottic edema by bronchoscopy. A tracheal tube (ID 5.5 mm) was intubated immediately through the LMA. Twenty hours later the pharyngeal edema was still very severe, and tracheotomy was performed. The edema disappeared three days later. We thought the edema had occurred as a result of blood flow disturbance caused by LMA in narrow pharyngeal space expanding to the epiglottis. It should be kept in mind that severe edema could develop after LMA in malignant rheumatoid arthritis.

Arthritis, Rheumatoid↗
PubMed1996

Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone.

OBJECTIVE: To evaluate the risk factors for postextubation laryngeal stridor and its prevention by hydrocortisone in adult patients. DESIGN: Prospective, randomized, double-blind, placebo controlled study. SETTING: Medical and surgical ICU of a tertiary teaching hospital. PATIENTS: 77 consecutive patients of both sexes, who had undergone tracheal intubation for more than 24 h and fulfilled the weaning criteria, were eligible for the study. Patients were excluded if they were less than 15 years of age, had a disease or the surgery of the throat, or had been extubated during the current hospitalization. INTERVENTION: The control group received placebo (normal saline 3 cc) and the experimental group received hydrocortisone 100 mg by intravenous infusion 60 min before extubation. MAIN OUTCOME MEASURES: Patients were observed 24 h after extubation for symptoms or signs of laryngeal edema or stridor: prolonged inspiration with accessory usage of respiratory muscles or crowing sound with inspiration or reintubation. RESULTS: The overall incidence of postextubation stridor was 22% (17/77). Only one patient (1%), who belonged to the control group, needed reintubation. 39% of female patients and 17% of male patients developed stridor. The relative risk of females developing this complication was 2.29. 7/39 of the hydrocortisone group and 10/38 of patients in the control group developed postextubation stridor. CONCLUSIONS: Hydrocortisone did not significantly reduce the incidence of postextubation laryngeal edema or stridor. From the risk factors evaluated, we were unable to demonstrate a statistical correlation between postextubation stidor and the duration of the intubation, the patient's age, the internal diameter of the endotracheal tube, or the route of intubation. However, female patients were more likely to develop this complication.

Aged↗
PubMed1998

Postextubation laryngeal edema: a review with consideration for home discharge.

Respiratory complications occurring in the immediate postoperative period are well known to the seasoned postanesthesia care unit nurse. The most common adverse respiratory events originating in this setting are airway obstruction, hypoventilation, hypoxemia, and pulmonary aspiration of gastric contents. The focus of this article details airway compromise secondary to edema of the larynx and adjacent structures as a consequence of translaryngeal intubation. Postextubation laryngeal edema is a relatively rare problem; however, severe episodes may have life-threatening ramifications. A review of pertinent airway anatomy and airflow dynamics as they relate to this compromised airway condition is presented. Risk factors for the development of postextubation laryngeal edema plus contemporary patient treatment strategies will be reinforced. Patient management issues are addressed, with emphasis placed on the ambulatory patient in which discharge to a remote location is anticipated.

Humans↗
PubMed1991

Life-threatening laryngeal edema in a pregnant woman previously treated for thyroid carcinoma.

A woman previously treated for papillary thyroid carcinoma developed life-threatening laryngeal edema during each of two pregnancies. The second episode led to tracheostomy. The laryngeal edema probably resulted from immobilization of the vocal cord(s), possibly caused by the thyroid carcinoma treatment combined with upper respiratory infection and the general tendency toward edema during pregnancy. Patients with a narrow upper respiratory airway must be adequately monitored during pregnancy because prompt intervention may be needed.

Adult↗