Maged Argalious, M.D., M.Sc., M.B.A, M.Ed.

Extubation is an elective process that requires careful planning and preparation. Following safe airway extubation strategies that can help improve outcomes will be the focus of a Wednesday fundamentals of anesthesiology session.

“Data from the ASA Closed Claims Project show that 17 percent of brain injuries and deaths occur after extubation in the operating room or post-anesthesia care unit,” said Maged Argalious, M.D., M.Sc., M.B.A, M.Ed., who will present “Extubation of the Difficult Airway With a Focus on Patient Outcomes.”

The session will review a stepwise approach for safe extubation in patients with a difficult airway, said Dr. Argalious, Professor of Anesthesiology at Lerner College of Medicine and Director of the Center for Anesthesiology Education at the Anesthesia Institute, both at Cleveland Clinic.

“Why do patients, after extubation, develop complications and how do we prevent those from happening?” he asked. “We will go through the potential causes for extubation failure and the preformulated plans for re-intubation in cases of extubation failure. There are published extubation guidelines from the Difficult Airway Society that we are going to highlight as well.”

Dr. Argalious said he would examine two common scenarios linked to extubation failure — patients developing a neck hematoma and those undergoing complex spine surgery. He also will discuss common causes for extubation failure, including pharyngeal obstruction, laryngeal edema, laryngospasm and pulmonary issues, such as pulmonary edema

Other topics that will be discussed include the correct use of airway exchange catheters and the correct performance and interpretation of the cuff leak test.

“The Closed Claims data are an underrepresentation of cases of extubation failure because not all cases of severe airway-related injuries result in a claim. In addition, it takes five years between the date of an injury to the entry of a claim into the database,” Dr. Argalious said. “Both local and national reporting of extubation failure cases should trigger peer review at the local level and result in data-driven national recommendations with a shorter feedback cycle.

“The use of collected data — locally and nationally — on patterns of airway injury to update airway management algorithms would reduce the cases of extubation failure and improve patient outcomes. The sharing of best practices and evidence-based extubation protocols through peer-reviewed publications also would reduce the cases of extubation failure and improve patient outcomes.”