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Intensive Care Med. 2003 Jan;29(1):69-74. Epub 2002 Nov 22.

Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test.

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1
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

Abstract

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.

PMID:
12528025
DOI:
10.1007/s00134-002-1563-4
[Indexed for MEDLINE]
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