Related Experiment Videos
Predictors of postextubation stridor in pediatric trauma patients
K J Kemper1, M S Benson, M J Bishop
1Department of Pediatrics, University of Washington, Seattle.
Insights
In pediatric trauma patients, the absence of an airleak around the endotracheal tube and facial burns are key predictors of postextubation stridor. These findings help identify high-risk children needing careful airway management after extubation.
Area of Science:
- Pediatric critical care medicine
- Trauma surgery
- Airway management
Background:
- Postextubation stridor is a significant concern in pediatric patients following mechanical ventilation.
- Identifying predictive factors for postextubation stridor is crucial for optimizing patient outcomes and resource allocation.
Purpose of the Study:
- To identify the most significant predictors of postextubation stridor in pediatric trauma patients.
- To guide clinical decision-making for airway management in this vulnerable population.
Main Methods:
- Prospective cohort study conducted in Burn and Trauma Intensive Care Units.
- Included pediatric patients (<15 years) intubated >12 hours without cardiopulmonary disease.
- Assessed risk factors: age, injury type, intubation location, tube size, intubation duration, and endotracheal tube airleak.
Main Results:
- Postextubation stridor requiring treatment occurred in 37% of extubations.
- Absence of an airleak around the endotracheal tube was the strongest predictor (sensitivity 100%, PPV 79%).
- Facial burns were the second strongest predictor (sensitivity 64%, PPV 88%).
Conclusions:
- Mechanism of injury (facial burn) and absence of an endotracheal tube airleak are the primary predictors of postextubation stridor in pediatric trauma patients.
- Patients with these risk factors require heightened attention to airway management strategies.
- These findings can inform proactive interventions to prevent or manage postextubation stridor effectively.
Objective:
To determine which factors are the best predictors of postextubation stridor in pediatric trauma patients.
Design:
Prospective cohort study.
Setting:
The Burn and Trauma ICUs at Harborview Medical Center from March to September 1989.
Patients:
Children were eligible for the study if they were less than 15 yr old, were intubated for greater than 12 hr, and did not have underlying cardiopulmonary disease. The study included 25 patients with 30 extubations. RISK FACTORS ASSESSED: Age, type of injury (burn vs. trauma), location of intubation ("field" vs. hospital), endotracheal tube size, length of intubation, and presence of an airleak around the tube at the time of extubation at 30 cm H2O pressure.
Main Outcome Measure:
Moderate to severe postextubation stridor requiring treatment with racemic epinephrine, helium-oxygen, reintubation, or tracheostomy.
Results:
Treatment for postextubation stridor was required after 11 (37%) of 30 extubations, with five reintubations and one tracheostomy. The best predictor of postextubation stridor was absence of an airleak at the time of extubation (sensitivity 100%, positive predictive value 79%, p less than .001), followed by type of injury (facial burn vs. all others; sensitivity 64%, positive predictive value 88%, p less than .001). After controlling for these two factors, no other factor studied was a significant predictor of postextubation stridor.
Conclusion:
In pediatric trauma patients, mechanism of injury (facial burn vs. other) and absence of an airleak at the time of extubation are the strongest factors predicting postextubation stridor. Patients with one or both risk factors require special attention to airway management.