Post-extubation stridor after prolonged intubation in the pediatric intensive care unit (PICU): a prospective observational cohort study

L L Veder, K F M Joosten, K Schlink, M K Timmerman, L J Hoeve, M P van der Schroeff, B Pullens, L L Veder, K F M Joosten, K Schlink, M K Timmerman, L J Hoeve, M P van der Schroeff, B Pullens

Abstract

Purpose: Prolonged endotracheal intubation may lead to laryngeal damage, with stridor being the most relevant clinical symptom. Our objective was to determine the incidence of post-extubation stridor and their clinical consequences in children within a tertiary referral center and to identify contributing factors.

Methods: 150 children, aged 0-16 years, intubated for more than 24 h were prospectively enrolled until discharge of the hospital. Potential relevant factors, thought to mediate the risk of laryngeal damage, were recorded and analyzed.

Results: The median duration of intubation was 4 days, ranging from 1 to 31 days. Stridor following extubation occurred in 28 patients (18.7%); 3 of them required reintubation due to respiratory distress and in 1 child stridor persisted for which a surgical intervention was necessary. In multivariate analyses, we found the following independent predictors of stridor: intubation on the scene, the use of cuffed tubes and lower age.

Conclusion: Despite a high incidence for post-extubation stridor, only few children need reintubation or surgical intervention as a result of post-extubation lesions. Intubation on the scene, the use of cuffed tubes and young age are associated with a significant increased risk of post-extubation stridor. Awareness of these factors gives the possibility to anticipate on the situation and to minimize laryngeal injury and its possible future consequences.

Keywords: Complications; Endotracheal tube; Laryngeal damage; Laryngotracheal stenosis; Pediatric airway; Prolonged intubation; Stridor; Subglottic stenosis.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart inclusion and follow-up patients

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Source: PubMed

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