Post-Intubation Laryngeal Edema

Laryngeal injuries are common after endotracheal intubation, which could manifest as varying degrees of edema, ulceration, granulation, and restricted vocal cord mobility, often resulting in luminal narrowing. Among these conditions, laryngeal edema is a common complication following intubation and usually results from the direct pressure and the inflammatory reaction triggered by the endotracheal tube on surfaces of contact. Nevertheless, although laryngeal edema is documented to be present in almost half of the extubated patients, the majority are asymptomatic or mildly symptomatic. On the other hand, laryngeal edema represents a common cause for breathing difficulty and/or stridor following extubation, thereby makes a common etiology for extubation failure and the need for reintubation. Thus, because reintubation is associated with augmented morbidity and mortality, the issue of post-intubation laryngeal edema is of paramount importance and needs for careful prevention and proper management. Post-intubation laryngeal edema (rather than the term 'post-extubation laryngeal edema') might be a more appropriate term to denote laryngeal edema, which has got the potential to cause respiratory difficulty and/or stridor following extubation. The pathologic process, which results in edema, indeed, starts soon after intubation though it becomes clinically evident only after removal of the endotracheal tube. The prompt recognition and management of post-intubation laryngeal edema before extubating a patient is extremely important, given the fact that any reintubation event could increase the morbidity and mortality of the patients. In this chapter, we discuss the etiology, epidemiology, clinical evaluation, and management of post-intubation laryngeal edema, highlighting the need for identification in high-risk patients with a prompt institution of preventive and treatment measures. The interprofessional team strategies for improving care coordination and communication and, in turn, outcomes will also be addressed.