Related Experiment Video
Updated: Jan 7, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Risk Factors and Clinical Outcomes of Post-Extubation Stridor in Pediatric Intensive Care
Jakeline Godinho Fonseca1,2, Cristiane Fernandes de Moura1, Geovana Soffa Rézio1,2
1Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Goiás (UFG), Goiânia 74690-900, Brazil.
Insights
Pediatric post-extubation stridor is common, with risk factors including intubation outside specialized centers and prolonged intubation. Stridor is linked to worse outcomes like longer PICU stays and increased extubation failure.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Respiratory Medicine
- Intensive Care Unit Management
Background:
- Post-extubation stridor is a significant complication in pediatric intensive care units (PICUs).
- Identifying risk factors and clinical outcomes associated with pediatric post-extubation stridor is crucial for improving patient management.
Purpose of the Study:
- To assess risk factors for post-extubation stridor in children.
- To evaluate the impact of post-extubation stridor on clinical outcomes in pediatric patients.
Main Methods:
- Prospective cohort study involving 239 children aged 0–13 years undergoing orotracheal intubation in PICUs.
- Data collected included patient characteristics, comorbidities, airway manipulation history, and intubation-related factors.
- Logistic regression analysis identified risk factors; outcomes analyzed until hospital discharge, death, or referral.
Main Results:
- Post-extubation stridor occurred in 57.3% of children.
- Risk factors identified: intubation in prehospital/non-specialized hospitals, intubation trauma/complications, and orotracheal intubation >7 days.
- Stridor associated with longer PICU stay, prolonged mechanical ventilation, higher non-invasive ventilation use, increased extubation failure, and cardiorespiratory arrest.
Conclusions:
- Intubation in non-specialized settings, prolonged intubation (>7 days), and intubation-related trauma are key risk factors for pediatric post-extubation stridor.
- Children with stridor experience poorer prognoses, including extended PICU and mechanical ventilation durations, and higher extubation failure rates.
Objectives:
To assess risk factors for post-extubation stridor in children and its impact on clinical outcomes.
Methods:
Prospective cohort study with children aged from 0 to 13 years who were intubated or underwent orotracheal intubation in the pediatric intensive care units (PICU) of two tertiary public hospitals. The outcome of interest was the occurrence of post-extubation stridor. The information collected included patient characteristics, comorbidities, history of airway manipulation, and factors related to orotracheal intubation. A logistic regression was used to identify potential risk factors for post-extubation stridor; data were analyzed until hospital discharge, death, or referral to another facility.
Results:
A total of 239 children were included, with a median age of 1.3 years and a duration of intubation of three days. Post-extubation stridor was observed in 57.3% of children. A multivariate analysis included prehospital or non-specialized hospital intubation, trauma or complications during intubation, and orotracheal intubation longer than seven days as risk factors for stridor. Children with stridor had a longer PICU length of stay, longer duration of invasive mechanical ventilation, and were often managed with non-invasive ventilation (p < 0.05). Most children with extubation failure (p = 0.001) and cardiorespiratory arrest (p = 0.03) presented with stridor.
Conclusions:
Risk factors for post-extubation stridor included intubation performed in prehospital or non-specialized hospitals, orotracheal intubation longer than seven days, and trauma or complications during intubation. Children with stridor had a worse prognosis, with longer stays in the PICU and on mechanical ventilation and higher rates of extubation failure.
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:30Cardiopulmonary Resuscitation V: Advanced Airway Management Techniques
01:30Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...