Nasotracheal Prolonged Safe Extubation Reduces the Need of Tracheotomy in Patients with Acute Respiratory Failure following Thyroidectomy

Objectives: Acute respiratory failure (ARF) is a complication following thyroid surgery; its incidence is reported as high as 0.9%. Through an illustrative case series, we present an alternative treatment of this peculiar ARF: the nasotracheal Prolonged Safe Extubation (PSE). Methods: Patients treated at our Intensive Care Unit for ARF following thyroid surgery from January 2004 to December 2009, were reviewed. Demographic data including gender, age, clinical presentation, laryngoscopic findings, management and outcome during a 24-months follow-up after treatment were collected and evaluated. The strategy for prolonged nasotracheal safe extubation is presented. Results: Twelve out of the 1713 patients scheduled for thyroid surgery (0.7%) at our university hospital, developed post-operative ARF. All of them were treated by nasotracheal prolonged safe extubation. The success rate in avoiding highly invasive treatment was of 83.3%, since only 2 patients needed tracheotomy (16.7%). Conclusions: The prolonged safe extubation reduced the amount of expected tracheotomies in patients with ARF following thyroid surgery. Thanks to its minimal invasiveness, and to the high degree of comfort, it was well tolerated