Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1029_Библиотеки_им_академика_М_И_Перельмана

91.4%, a positive predictive value of 90.9%, a specicity of 90.8%, and a negative predictive value of 88.2%. However, it has not been vali­dated in larger prospective or randomized trials. Although it is the most ‘user-friendly’ score available, this study has some important limita­tions. In the retrospective series data, there was a surprising number of patients who required late tracheostomy due to clinical features of airway obstruction and did not report on rate of returns to theatre in the cohort, or details of length of post-operative intubation, or reasons for late tra­cheostomy, or other relevant details that may be relevant to a preoperative decision on whether a tracheostomy is needed. The most glaring limita­tion however is that it compares those who should have tracheostomy or undergo delayed extuba­tion. Overall, we consider delayed extubation at 24-48h somewhat counterintuitive as the major­ity of post-operative oedema is expected between 48 and 72h post- operatively, so delayed extuba­tion at 24–48h may miss the time when risk of upper airway oedema is likely to be the greatest. It also requires intensive care support compared to a tracheostomy, which can be easily managed on the ward by an experienced nursing team. Also, when deciding on the appropriateness of post-operative extubation, exible nasoendos­copy while intubated to assess for a clear upper airway is difcult due to secretions, multiple tubes, and soft tissue collapse while sedated. However, teams experienced with delayed extu­bation report good predictable results [7]. In our experience, if the head and neck surgeon is wor­ried enough about upper airway obstruction for the rst 24–48 h to keep the patient intubated, then a tracheostomy is probably warranted.