PURPOSE: Postextubation stridor (PES) is a feared complication of extubation. Because extubation is so common, there has been considerable interest in predicting the development of PES. Duration of intubation, female gender, ratio of endotracheal tube (ETT) to laryngeal size, upper airway trauma, burns, or surgery, body mass index (BMI), cuff leak test (CLT), air column width by laryngeal ultrasound, and laryngoscopic features have been identified as predictive factors for PES. However, there has not been a comprehensive study looking at all of these factors together.
METHODS: 51 adult patients were prospectively evaluated in the medical and surgical intensive care units. Prior to extubation, a qualitative cuff leak test, laryngeal ultrasound, and indirect laryngoscopy were performed. A grading system for laryngeal view was developed (Figure 1). In addition, body mass index (BMI), estimated laryngeal AP diameter, and ETT size to laryngeal size ratio was obtained on each patient.
RESULTS: The CLT during inspiration showed a significant leak in 30/51(59%) patients, a minimal leak in 11/51(22%) patients, and no leak in 10/51(20%) patients. The average air column width on laryngeal ultrasound with the cuff deflated was 0.66 cm (range 0.39–1.22 cm). Laryngeal edema was present on laryngoscopy in 5 of 51 patients (10%). The average laryngoscopic view was grade 3 (range 1 to 5). The average ratio of ETT outside diameter to laryngeal AP diameter was 0.48 (range 0.34 to 0.66). Comparing the cuff leak to the ETT/laryngeal diameter ratios, there was progressively less leak with larger ratios, which did not meet statistical significance. PES occurred in only 2(3.9%) patients. There was no significant correlation between any of the parameters studied and the development of PES.
CONCLUSION: This study is consistent with others showing a low incidence of PES. Even combining multiple refinements, no single aspect of the CLT or combination proved helpful.
CLINICAL IMPLICATIONS: The CLT should not be used to screen patients for the development of PES prior to extubation.
DISCLOSURE: Anit Patel, No Financial Disclosure Information; No Product/Research Disclosure Information