title: Post-extubation stridor: risk factors and outcome.
abstract: Post-extubation stridor is a potential complication of endotracheal intubation. The incidence, risk factors, and outcome in adult patient populations are poorly defined. It was our clinical impression that the occurrence of post-extubation stridor in our medical intensive care unit was more frequent than generally reported. We therefore monitored all intubated patients to determine the incidence of post-extubation stridor and to identify any predisposing factors. All adult patients requiring endotracheal intubation and medical intensive care admission were prospectively observed over a 5-month period in a university-affiliated medical intensive care unit. Sixty-seven patients requiring intubation and medical intensive care admission were evaluated. Twenty-two patients were excluded from analysis because no extubation was attempted. The remaining 45 patients were divided into two groups: 8 with and 37 without post-extubation stridor. Of the parameters analyzed, cuff pressure, treatment with corticosteroids at the time of extubation, and the presence of a primary neurologic process necessitating intubation differed significantly between groups. Six of the 8 patients who developed post-extubation stridor required reintubation. Four of these patients were subsequently successfully extubated, one required tracheostomy, and one patient died after a 2-week deteriorating clinical course. The incidence of significant stridor in our population was 17.8%. Medical management was successful in the majority of patients with post-extubation stridor. Routine tracheostomy following a single episode of post-extubation stridor is not indicated. Further investigation regarding risk factors and a placebo-controlled trial evaluating the efficacy of systemic corticosteroids before extubation in individuals at risk for developing post-extubation stridor are needed.
authors.affiliation: Department of Internal Medicine, SUNY Health Science Center at Brooklyn, Kings County Hospital Center 11203, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Efferen
authors.forename: A
authors.initials: A
authors.lastname: Elsakr
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007819:Laryngeal Edema / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000209:etiology*; D012307:Risk Factors