Extubation of the Difficult Airway and Endotracheal Tube Change in the Surgical Intensive Care Unit

Extubation of a known difficult airway and especially planned endotracheal tube (ETT) change in a critically ill patient shouldbeapproachedwith asimilardegreeof concern and preparation as that given to initial intubation. That is, the patient should be evaluated for difficulty of reintubation due to known anatomic or pathologic airway conditions. In addition, the likelihood of difficulty maintaining cardiopulmonary function during the reintubation interval must be incorporated into the airway plan of patients dependent upon high levels of ventilatory support. Similarly, perturbations in intracranial pressure (ICP) in patients with decreased intracranial compliance must be considered in trauma patients requiring ETT change. The basic aphorism “Never take out that which you can not put back in” should be followed when the tube is critical to the patient’s survival.