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Published on: January 17, 2011
Factors Associated With Post-Extubation Stridor in Infants Intubated in the Pediatric ICU
Deirdre Lewis1, Dev Darshan Khalsa2, Alexandra Cummings1
1Department of Pediatrics, Division of Critical Care Medicine, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA.
Insights
Prolonged mechanical ventilation and nonelective intubation increase post-extubation stridor risk in infants. Larger endotracheal tubes (4.0) are also linked to higher stridor rates, guiding clinical decisions.
Area of Science:
- Pediatric Intensive Care
- Critical Care Medicine
- Neonatology
Background:
- Post-extubation stridor (PES) is a frequent complication in the pediatric intensive care unit (PICU).
- Infants are particularly vulnerable to PES, which can lead to extubation failure, prolonged hospital stays, and increased mortality.
- Identifying risk factors for PES in infants is crucial for improving outcomes.
Purpose of the Study:
- To investigate factors associated with post-extubation stridor in infants (under 1 year) admitted to the PICU.
- To determine the impact of ventilation duration, intubation type, and endotracheal tube size on PES development.
Main Methods:
- Retrospective review of 518 infant patient charts from the PICU.
- Primary outcome: PES, defined by the need for racemic epinephrine within 6 hours of extubation.
- Statistical analysis included Fisher's exact test and multivariate logistic regression.
Main Results:
- 24.1% of infants developed PES.
- Mechanical ventilation exceeding 48 hours (OR=1.75) and nonelective intubation (OR=2.92) significantly increased PES risk.
- Endotracheal tubes size 4.0 (OR=1.96) showed a higher association with PES compared to size 3.5.
Conclusions:
- Mechanical ventilation duration over 48 hours and nonelective intubation are key risk factors for PES in infants.
- Endotracheal tube size 4.0 is associated with an increased risk of PES compared to size 3.5.
- These findings aid in selecting appropriate endotracheal tubes and identifying high-risk infants for PES prevention strategies.
Background:
Post-extubation stridor (PES) is a common problem in the pediatric intensive care unit (PICU) and is associated with extubation failure, longer length of stay, and increased mortality. Infants represent a large proportion of PICU admissions and are at higher risk for PES, making identification and mitigation of factors associated with PES important in this age group.
Research Question:
What factors are associated with PES in infants (age less than 1 year) intubated in the PICU?
Study Design & Methods:
The primary outcome was PES as defined by the need for racemic epinephrine within 6 h of extubation. Secondary outcomes were heliox administration and reintubation. Statistical analyses were performed with Fisher's exact test for univariate analyses and multivariate logistic regression.
Results:
518 patient charts were retrospectively reviewed. 24.1% of patients developed PES. Duration of mechanical ventilation greater than 48 h was associated with increased risk of PES (odds ratio [OR] = 1.75, 95% confidence interval [CI] 1.13-2.71, P = .01), as was nonelective intubation (OR = 2.92, 95% CI 1.91-4.46, P < .01). The presence of a cuff, gastroesophageal reflux disease, prematurity, and known upper airway abnormality had no association with PES. 4.0 endotracheal tubes (ETTs) had an increased association with PES compared to 3.5 ETTs (OR = 1.96, 95% CI 1.18-3.27, P < .01). There was no difference in risk of PES between 3.5 and 3.0 ETTs.
Interpretation:
In infants intubated in the PICU, mechanical ventilation greater than 48 h and nonelective intubation were associated with PES. 4.0 ETTs were associated with higher risk of PES compared to 3.5 ETTs. These findings may help providers in ETT selection and to identify infants that may be at increased risk of PES.
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