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305: AIRWAY EXCHANGE CATHETER USE IN MEDICAL ICU PATIENTS AT HIGH RISK FOR EXTUBATION FAILURE

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: Planned extubation fails in up to 20% of patients in the intensive care unit (ICU), and may be more common in patients with certain risk factors. Re-intubation is associated with increased mortality and morbidity; in part, due to clinical deterioration resulting from extubation failure and the scenario of reintubation, which can be difficult due to anatomical or physiological abnormalities. In patients at risk for extubation failure, a strategy that allows for ongoing respiratory support and reduces delay and difficulty in reintubation is ideal. Airway exchange catheters (AEC) have been shown to be safe and efficacious for providing continuous airway access for rapid reintubation following planned extubation. The use of these devices in medical ICU patients is not well-reported or studied. Methods: We present 7 adult patients admitted to a medical ICU at an academic medical center who underwent 8 separate placements of a Cook® AEC (Cook Medical, Bloomington, IN, USA) following planned extubation. Patients were at risk of extubation failure due to multiple factors including morbid obesity (4/8 [50%]), prior extubation failure (4/8 [50%]), chronic respiratory failure (3/8 [37.5%], and difficult initial intubation (1/8 [12.5%]). In total, 5/8 (62.5%) AEC placements were followed by reintubation on the first attempt. Reintubation in 4/8 (50%) of cases incorporated the use of a GlideScope® video laryngoscope (Verathon, Seattle, WA, USA) with 3 of those cases also incorporating the use of an Aintree intubation catheter (Cook Medical, Bloomington, IN, USA). All patients tolerated the AEC well, and there were no complications directly related to the AEC. Results: Extubation failure is a frequent occurrence in ICU patients, yet no guidelines for extubation address the unique population of medical ICU patients. In this small series of medical ICU patients determined to be at high risk for extubation failure, placement of an AEC facilitated safe and rapid replacement of an endotracheal tube. Further study may help delineate the ideal method for implementation.