title: Impact of monitoring endotracheal tube cuff leak pressure on postextubation stridor in children.
abstract: To determine if implementing a protocol maintaining an air leak when using cuffed endotracheal tubes (ETT) throughout the course of mechanical ventilation (MV) in children would decrease the rate of postextubation stridor (PES).
  
  
  
  All children requiring MV through a cuffed ETT were included, except those with (1) upper airway anomaly, (2) died while on MV, (3) received tracheostomy before extubation, and (4) transferred before extubation. We implemented a protocol limiting the volume of air instilled into the cuff, allowing an air leak by 25 cm H2O pressure or by peak inspiratory pressure, whichever was higher. Monitoring occurred every 6 hours, adjusting cuff volumes if necessary. Patients receiving nebulized racemic epinephrine within 24 hours of extubation for upper airway obstruction were defined as having PES.
  
  
  
  At baseline, 110 patients received cuffed ETTs. The proportion of patients who had an air leak at the time of extubation was 47.3%, and that who developed PES was 21.8%. During the intervention, 101 patients received cuffed ETTs. Most (72.3%) had an air leak at the time of extubation (P< .01), and 9.9% developed PES, a 54.6% relative decrease (relative risk, 0.45; 95% confidence interval, 0.22-0.90; P= .018).
  
  
  
  Maintaining an appropriate air leak throughout the course of MV using cuffed ETT decreases the rate of PES in children.
authors.affiliation: Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, New Hyde Park, NY. Electronic address: jschneide2@nshs.edu.
authors.forename: James
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Boston Children's Hospital, Boston, MA.
authors.forename: Unami
authors.initials: U
authors.lastname: Mulale
authors.affiliation: The Permanente Medical Group, Kaiser San Leandro Medical Center, San Leandro, CA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Yamout
authors.affiliation: Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, New Hyde Park, NY.
authors.forename: Sharon
authors.initials: S
authors.lastname: Pollard
authors.affiliation: Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, New Hyde Park, NY.
authors.forename: Peter
authors.initials: P
authors.lastname: Silver
mesh_terms: D000293:Adolescent; D060666:Airway Extubation; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D011312:Pressure; D012121:Respiration, Artificial / Q000379:methods*; D012135:Respiratory Sounds; D012189:Retrospective Studies
keywords: Airway obstruction; Endotracheal extubation; Mechanical ventilation; Pediatric critical care