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Intensive Care Medicine

, Volume 29, Issue 1, pp 69–74 | Cite as

Post-extubation stridor in intensive care unit patients

Risk factors evaluation and importance of the cuff-leak test
  • Samir Jaber
  • Gérald Chanques
  • Stefan Matecki
  • Michèle Ramonatxo
  • Christine Vergne
  • Bruno Souche
  • Pierre-François Perrigault
  • Jean-Jacques Eledjam
Original

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.

Post-extubation stridor Airway obstruction Laryngeal edema Extubation failure Cuff-leak test Helium-oxygen Unplanned extubation 

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Samir Jaber
    • 1
  • Gérald Chanques
    • 1
  • Stefan Matecki
    • 2
  • Michèle Ramonatxo
    • 2
  • Christine Vergne
    • 3
  • Bruno Souche
    • 1
  • Pierre-François Perrigault
    • 1
  • Jean-Jacques Eledjam
    • 1
  1. 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
  2. 2.Service central de Physiologie Clinique, Chu de Montpellier Hopital Arnaud de Villeneuve, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
  3. 3.Department of Biostatistics, Faculty of Medicine, Chu de Montpellier Hopital Arnaud de Villeneuve, 371, avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France

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