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Updated: May 8, 2026

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways
08:21

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

Published on: April 7, 2023

Prediction of post-extubation stridor using ultrasound measurement of subglottic airway diameter

Nichanan Jongthitinon1, Kantara Saelim1, Supika Kritsanepaiboon2

  • 1Division of Pulmonology and Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand.

The Ultrasound Journal
|May 7, 2026
PubMed

Insights

Intracricoid peritubular free space (IPFS) ultrasonography shows promise for predicting post-extubation stridor (PES) in children. This method, along with subglottic ratio, aids in identifying children at risk for PES after intensive care.

Area of Science:

  • Pediatric Intensive Care
  • Medical Imaging
  • Respiratory Medicine

Background:

  • Post-extubation stridor (PES) is a frequent complication in pediatric intensive care units (PICU).
  • Current predictive methods for PES lack consistent diagnostic utility.
  • Subglottic diameter ultrasonography is explored for its potential in predicting PES.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of subglottic diameter ultrasonography for predicting PES in children.
  • To assess the utility of subglottic ratio (SR) and intracricoid peritubular free space (IPFS) in predicting PES within 48 hours post-extubation.

Main Methods:

  • A prospective observational study was conducted in a university-affiliated PICU.
  • Children aged 1 month to 15 years, post-spontaneous breathing trial (SBT), were enrolled.
  • Subglottic ultrasonography was performed during SBT and cuff deflation to calculate SR and IPFS.

Main Results:

  • PES occurred in 18.75% of patients (33/176).
  • IPFS <2.08 mm showed 80% sensitivity and 65% specificity for PES.
  • SR <1.30 demonstrated 70% sensitivity and 65% specificity for PES in children aged ≥1 year.

Conclusions:

  • Intracricoid peritubular free space (IPFS) exhibited the highest diagnostic performance for predicting PES.
  • IPFS slightly outperformed the subglottic ratio in predicting PES in children aged one year and older.
Abstract

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