Utility of airway exchange catheters in pediatric patients with a known difficult airway.

OBJECTIVE To evaluate the utility of the Cook airway exchange catheter (CAEC) for extubation/reintubation in pediatric patients with a known difficult airway. DESIGN Prospective, nonrandomized. SETTING Pediatric intensive care unit; single academic institution. PATIENTS Twenty intubated children </=18 yrs of age with a known difficult airway requiring extubation. INTERVENTIONS The CAEC was inserted into the trachea before extubation in children with a known difficult airway who were at risk for a difficult reintubation. The CAEC provided a means of a "guided" reintubation while maintaining the ability to provide supplemental oxygenation directly into the trachea. MEASUREMENTS AND MAIN RESULTS The respiratory rate, oxygen saturation, and amount of oxygen administered were measured immediately before extubation and at 5-, 15-, 30-, and 60-min intervals thereafter. In addition, the child's ability to tolerate the CAEC was noted and rated (0 = tolerable without difficulty, 1 = tolerable with difficulty, 2 = intolerable). No sedatives were administered in the presence of the CAEC. The duration of the CAEC placement was dependent on the satisfaction of the child's airway patency as determined by the unlikely need for reintubation. Five of the 20 (25%) children who had been extubated were reintubated in the intensive care unit with the assistance of the CAEC. Three of the five (60%) children were reintubated for upper airway obstruction. The ability to provide supplemental oxygen through the CAEC into the trachea during reintubation diminished the potential for hypoxia and maintained the ability to reintubate the trachea using the CAEC as a guidewire to pass an endotracheal tube. CONCLUSIONS In children with a known difficult airway who are at risk for a difficult reintubation, the CAEC is a useful tool for a trial of extubation in the intensive care unit.