Algorithms are becoming increasingly popular as a standardized approach to difficult and unique problems. Many resources have been spent on searching for a perfect algorithm for difficult intubations. In this issue, Voscopoulos et al. have proposed in this article an algorithm of extubation in the operating room after a difficult intubation. In this editorial we will first concentrate on the ne...

BACKGROUND The modified nasal trumpet (MNT) is a prepackaged nasopharyngeal airway modified with distal holes and fitted with a 15 mm adaptor allowing connection to an anaesthesia circuit. It may be useful for airway management during anaesthesia. METHODS After applying a spray to constrict the nasal mucosa, we used the MNT in 346 spontaneously breathing patients for three indications: alone ...

Endotracheal intubation and extubation in intensive care unit (ICU) patients are difficult. Extubation will be more worrisome if patient has difficult intubation, sleep apnea, surgical procedure involving airway or surrounding structures. In such extubation airway exchange catheters (AEC) are used, as they are simple to use and able to provide oxygen to the patient. Rarely AEC use can cause pot...

BACKGROUND The presence of Haemophilus influenzae in the oropharynx is correlated with the subsequent development of chest infection. The importance of colonisation of the trachea by bacteria at the time of surgery is uncertain. This study investigated the tracheal flora at the time of intubation in 24 patients undergoing elective upper abdominal surgery. METHODS The bacterial flora of the tr...

BACKGROUND Unplanned extubation (UE) is an unprecedented happening in pediatric intensive care unit (PICU); which may lead to severe complications in patients. The risk factors of UE have been discussed but much details are still required in this regard. This study aimed to evaluate predisposing and risk factors of unplanned extubation in PICU. MATERIALS AND METHODS Patients intubated in PICU...

In preterm infants, the need for intubation and mechanical ventilation is associated with ventilator-induced lung injuries and subsequent bronchopulmonary dysplasia. The aim of the present review was to improve the understanding of the mechanisms of injury that involve cytokine-mediated inflammation to contribute to the development of new preventive strategies. Relevant articles were retrieved ...

a study published in the previous issue of Critical Care, Gonçalves and colleagues [1] observed a 33% reduction in re-intubation rate in the study group, due to eff ective management of bronchial secretions. Current evidence favors early implementation of noninvasive mechanical ventilation (NIV) in the post-extubation period to reduce re-intubation, especially in patients with hypercapnic respi...

Significant swelling of the thyroid compromising the airway can be a challenging situation when combined thyroidectomy and cardiac surgery is planned. Induction, intubation, intraoperative management, and extubation require special attention in such cases.

We read with interest the recently published review in Critical Care about post-extubation laryngeal edema and stridor by Pluijms et al. [1]. The review considers in detail the risk factors for post-extubation respiratory failure and describes a post-extubation algorithm for its prevention and reduction. We recently published a case report describing the occurrence of post-extubation stridor le...

Retropharyngeal or parapharyngeal abscesses developing after intubation are rare. This can present as surgical emergency post extubation. We report a case of retropharyngeal abscess that probably occurred as a complication of laryngeal mask insertion.