Post-extubation stridor: risk factors and outcome

Area of Science:

• Critical Care Medicine
• Pulmonology
• Anesthesiology

Background:

• Post-extubation stridor is a recognized complication of endotracheal intubation.
• The incidence, risk factors, and outcomes in adult populations remain incompletely defined.
• Clinical observations suggested a higher frequency of post-extubation stridor than typically reported.

Purpose of the Study:

• To determine the incidence of post-extubation stridor in a medical intensive care unit.
• To identify predisposing factors associated with its occurrence.
• To evaluate the outcomes and management strategies for post-extubation stridor.

Main Methods:

• Prospective observational study over 5 months in a university-affiliated medical intensive care unit.
• Inclusion of all adult patients requiring endotracheal intubation and intensive care.
• Analysis of 45 patients who underwent extubation, comparing those with and without stridor.

Main Results:

• The incidence of significant post-extubation stridor was 17.8% (8 out of 45 patients).
• Significant risk factors included cuff pressure, corticosteroid treatment at extubation, and primary neurologic conditions.
• Six of 8 patients with stridor required reintubation; most were successfully managed medically, with one tracheostomy and one death.

Conclusions:

• Post-extubation stridor affects a notable percentage of intubated patients.
• Cuff pressure, corticosteroid use, and neurologic status are key factors to consider.
• Medical management is effective for most cases, and routine tracheostomy is not indicated; further research on corticosteroids is warranted.