According to the SFAR-SRLF joint guidelines, how is extubation failure prevented following a rapid sequence intubation?

Updated: Apr 07, 2020
  • Author: Keith A Lafferty, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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To predict the occurrence of laryngeal edema, perform a cuff leak test before extubation. If the patient has at least one risk factor for inspiratory stridor, the cuff leak test is recommended before extubation to reduce the risk of failure related to laryngeal edema.

During mechanical ventilation, it is recommended to institute measures to prevent and treat laryngeal pathology.

In the event the leak volume is low or zero, corticosteroids can be prescribed to help prevent extubation failure related to laryngeal edema. If corticosteroid therapy is selected, the recommendation is to start it at least 6 hours before extubation.

For pediatric patients, corticosteroid therapy should be started 24 hours pre-extubation in order to be effective.

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