Perioperative upper airway edema: Risk factors and management

Objectives: To study the risk factors and treatment of the postoperative patient who develops upper airway edema.
Design: Retrospective analysis.
Setting: Surgical Intensive Care Unit (SICU) of a tertiary care hospital.
Patients and participants: We performed a retrospective analysis over 24 months of SICU admissions of postoperative patients. Inclusion criteria were (1) failure to extubate after a surgical procedure, (2) a negative cuff leak test immediately postop (<110 mL of tidal volume loss with the cuff deflated), and (3) failure to extubate within 24 hours with suspected airway edema. Six patients met criteria for study. Interventions: Management of these patients included a multimodal strategy including a daily cuff leak test, use of corticosteroids, diuretics, and head of bed elevation. Measurements and results: All patients were female, with a mean age of 54.5-year-old. The majority had operations remote from the neck region. The mean body mass index (BMI) was 34.8, and the mean surgical time was 282 minutes. Two thirds of the patients were given blood products intraoperatively with a mean of 17.3 units transfused. The mean fluid balance intraoperatively was +5 L. Using our protocol, steroids were administered in the equivalence of 389 mg of hydrocortisone across a mean of 71 hours of mechanical ventilation. Simultaneously, they received a mean of 63 mg of furosemide to achieve a mean fluid balance of -2.8 L. All patients were extubated when the cuff leak became positive; none required reintubation. Conclusion: A multimodal strategy for the patient with postoperative upper airway edema is recommended.