Allena Nishant, Penikilapate Shalini, Allu Sai, Vakde Trupti
Pulmonary Medicine, BronxCare Health System, Bronx, USA.
Internal Medicine, BronxCare Health System, Bronx, USA.
Cureus. 2025 Feb 8;17(2):e78740. doi: 10.7759/cureus.78740. eCollection 2025 Feb.
Post-extubation stridor poses a significant challenge in critical care settings, often necessitating prompt intervention to prevent respiratory compromise and potential reintubation. This case report details the successful management of post-extubation stridor in a 55-year-old female patient with a complex medical history, using heliox therapy. Heliox, a gas mixture of helium and oxygen, has emerged as a novel therapeutic option in such scenarios, owing to its ability to reduce airway resistance and improve gas flow dynamics. Following the patient's elective intubation for MRI imaging, she developed hoarseness, loud breathing, and stridor upon extubation, indicative of subglottic edema and bilateral vocal cord paralysis. Despite initial treatment with conventional modalities yielding minimal improvement, heliox therapy (70%/30%) with supplemental oxygen was initiated, resulting in significant alleviation of symptoms. Subsequent maintenance therapy with corticosteroids and bronchodilators further facilitated the resolution of respiratory distress. This case underscores the pivotal role of heliox therapy as an effective adjunct in managing post-extubation stridor, offering rapid relief and potentially obviating the need for reintubation. Moreover, it highlights the importance of innovative therapeutic approaches in optimizing outcomes for patients with respiratory distress in critical care settings. However, further research is warranted to elucidate the optimal utilization criteria and long-term efficacy of heliox therapy in this context.
拔管后喘鸣在重症监护环境中构成重大挑战,通常需要迅速干预以防止呼吸功能不全和潜在的再次插管。本病例报告详细介绍了一名有复杂病史的55岁女性患者拔管后喘鸣的成功管理,采用了氦氧混合气疗法。氦氧混合气是氦气和氧气的混合气体,由于其能够降低气道阻力并改善气流动力学,已成为此类情况下一种新的治疗选择。该患者因MRI成像进行择期插管后,拔管时出现声音嘶哑、呼吸声大及喘鸣,提示声门下水肿和双侧声带麻痹。尽管最初采用传统方式治疗改善甚微,但仍启动了补充氧气的氦氧混合气疗法(70%/30%),症状得到显著缓解。随后使用皮质类固醇和支气管扩张剂进行维持治疗进一步促进了呼吸窘迫的缓解。本病例强调了氦氧混合气疗法作为管理拔管后喘鸣的有效辅助手段的关键作用,能迅速缓解症状并可能避免再次插管的需要。此外,它突出了创新治疗方法在优化重症监护环境中呼吸窘迫患者治疗效果方面的重要性。然而,有必要进一步研究以阐明氦氧混合气疗法在此背景下的最佳使用标准和长期疗效。