Document Detail

Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test.
MedLine Citation:
PMID:  12528025     Owner:  NLM     Status:  MEDLINE    
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. DESIGN: Prospective, clinical investigation. SETTING: Intensive care unit of a university hospital. PATIENTS: Hundred twelve extubations were analyzed in 112 patients during a 14-month period. INTERVENTION: A cuff-leak test before each extubation. MEASUREMENTS AND 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. CONCLUSION: 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.
Samir Jaber; Gérald Chanques; Stefan Matecki; Michèle Ramonatxo; Christine Vergne; Bruno Souche; Pierre-François Perrigault; Jean-Jacques Eledjam
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Publication Detail:
Type:  Journal Article     Date:  2002-11-22
Journal Detail:
Title:  Intensive care medicine     Volume:  29     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-15     Completed Date:  2003-06-05     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  69-74     Citation Subset:  IM    
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.
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MeSH Terms
Airway Obstruction / epidemiology,  etiology,  prevention & control*
France / epidemiology
Intensive Care Units
Intubation, Intratracheal / adverse effects*,  instrumentation
Laryngeal Edema / etiology,  prevention & control
Manometry / methods*
Middle Aged
Prospective Studies
ROC Curve
Respiratory Sounds / etiology*
Risk Factors
Sensitivity and Specificity
Statistics, Nonparametric

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