Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test.
OBJECTIVE
To evaluate the incidence and identify factors associated with the occurrence of post-extubation stridor and to evaluate the performance of the cuff-leak test in detecting this complication.


METHODS
Prospective, clinical investigation.


METHODS
Intensive care unit of a university hospital.


METHODS
Hundred twelve extubations were analyzed in 112 patients during a 14-month period.


METHODS
A cuff-leak test before each extubation.


RESULTS
The incidence of stridor was 12%. When we chose the thresholds of 130 ml and 12% to quantify the cuff-leak volume, the sensitivity and the specificity of the test were, respectively, 85% and 95%. The patients who developed stridor had a cuff leak significantly lower than the others, expressed in absolute values (372+/-170 vs 59+/-92 ml, p<0.001) or in relative values (56+/-20 vs 9+/-13%, p<0.001). Stridor was associated with an elevated Simplified Acute Physiology Score (SAPS II), a medical reason for admission, a traumatic or difficult intubation, a history of self-extubation, an over-inflated balloon cuff at admission to ICU and a prolonged period of intubation. These results provide a framework with which to identify patients at risk of developing a stridor after extubation.


CONCLUSIONS
A low cuff-leak volume (<130 ml or 12%) around the endotracheal tube prior to extubation is useful in identifying patients at risk for post-extubation stridor.
Jaber
Samir
S
Department of Anesthesiology, Intensive Care and Transplantation Unit (DAR B), Chu de Montpellier Hopital Saint Eloi, 80, avenue Augustin Fliche, 34295 Montpellier Cedex 5, France. s-jaber@chu-montpellier.fr
Chanques
Gérald
G
Matecki
Stefan
S
Ramonatxo
Michèle
M
Vergne
Christine
C
Souche
Bruno
B
Perrigault
Pierre-François
PF
Eledjam
Jean-Jacques
JJ
D000402:Airway Obstruction / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D007819:Laryngeal Edema / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008365:Manometry / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012135:Respiratory Sounds / Q000209:etiology*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric