Interrater Reliability of Point-of-Care Ultrasound for Predicting Post-Extubation Stridor in Pediatrics

Area of Science:

• Pediatric Critical Care Medicine
• Point-of-Care Ultrasound (POCUS)
• Respiratory Physiology

Background:

• Post-extubation stridor (PES) is a significant complication in pediatric patients after endotracheal intubation, often associated with laryngeal edema.
• Laryngeal air column width difference (LACWD), measured via POCUS, has been proposed as a potential predictor of PES.

Purpose of the Study:

• To evaluate the predictive value of LACWD for PES in pediatric patients.
• To examine the correlation between LACWD and endotracheal tube (ETT) cuff pressure.
• To assess the interrater reliability of LACWD measurements by POCUS-trained providers.

Main Methods:

• A prospective observational study involving 51 mechanically ventilated pediatric patients (0-18 years).
• LACWD was measured using bedside POCUS; duplicate scans were performed by different providers to assess interrater reliability.
• PES was identified by inspiratory stridor; reliability was quantified using intraclass correlation coefficients (ICCs).

Main Results:

• PES occurred in 14% of the study population.
• No significant difference in LACWD was observed between patients with and without PES.
• LACWD measurements demonstrated excellent intrarater reliability (ICC >0.95) but poor interrater reliability (ICC = 0.27).

Conclusions:

• LACWD measurements did not reliably predict PES in pediatric patients and exhibited poor interrater reliability.
• The current POCUS technique for LACWD measurement lacks the necessary reproducibility for widespread clinical application among different providers.
• Further advancements in POCUS techniques may be needed to enhance feasibility and reliability for routine bedside use in pediatric critical care.