Role of estimation of arterial blood gases in the management of stridor

  • M. Panduranga Kamath
  • Mahesh Chandra Hegde
  • Suja Sreedharan
  • Kiran Bhojwani
  • Vandana Vamadevan
  • K. V. Vishwas
Original Article



We studied the epidemiology and etiology of stridor in our patients along with the role of arterial blood gas (ABG) analysis in their management. We also reviewed their prognostic indices and the clinical outcomes.

Materials and methods

It was a prospective study in a tertiary referral hospital in which 72 patients presenting with stridor, were independently evaluated by 3 different clinicians and clinically classified into mild, moderate and severe. Based on ABG values (pH, PO2, PCO2), we defined 3 groups of patients viz, those in respiratory failure, impending respiratory failure and those with no evidence of failure. Treatment was directed at the cause of stridor. Clinical outcomes were assessed and results classified as resolved, improved, stable and death.


Out of 72 patients, kappa coefficient of agreement between the 3 observers were found to be 0.014, indicating poor interobserver reliability for the working clinical classification. However, ABG analysis indicated otherwise, with 6 patients in respiratory failure, 19 progressing to impending failure. Hence we complied by the more objective ABG analysis in planning management. Laryngomalacia in children and hypopharyngeal malignancies in adults were found to be the most common causes of stridor in our study. As compared to other conditions, laryngomalacia in children had a poorer outcome (p = 0.001).


Early detection of impending respiratory failure was instrumental in achieving better clinical outcomes in our patients presenting with stridor. Thus we inferred that ABG analysis is a valuable tool in the effective management of stridor.


Stridor Blood gas analysis Tracheostomy Endotracheal intubation Respiratory failure 


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  1. 1.
    Cotton RT (1995) Stridor and airway obstruction: Ped Otolaryngology 3rd edition. 1275–1286Google Scholar
  2. 2.
    Cowan DL (2000) Laryngeal Stridor. AGD Maran 10th edition, logan turners diseases of the nose throat and ear. Oxford Butter worth-Heinemann LtdGoogle Scholar
  3. 3.
    Sahoo GC (2003) Role of blood gas analysis as a parameter for emergency tracheostomy in children. Antiseptic 100(12):481–482Google Scholar
  4. 4.
    Mancuso RF (1996) Stridor in neonates. Pediatr Clin North Am 43(6):1339–1356CrossRefPubMedGoogle Scholar
  5. 5.
    Davis HW, Gartner JC, Galvis AG, et al. (1981) Ped clin N Amer 28:859Google Scholar
  6. 6.
    Bent, et al. (2006) Current perspectives on stridor. Laryngoscope 116(7):1059–1070CrossRefPubMedGoogle Scholar
  7. 7.
    Moralee SJ, Reilly PG (1992) Metabolic stridor: bilateral vocal cord abductor paralysis secondary to hypokalemia. J Laryngol Otol 106(1):56–57CrossRefPubMedGoogle Scholar
  8. 8.
    Campbell EJM (1965) Respiratory failure. Br Med J 1(5448):1451–1460CrossRefPubMedGoogle Scholar
  9. 9.
    Olney, et al. (1999) Laryngomalacia and its treatment. Laryngo 109:1770–1775CrossRefGoogle Scholar
  10. 10.
    Belmont JR, Grundfast K (1984) Congenital laryngeal stridor (laryngomalacia): Etiologic factors and associated disorders. Ann Otol Rhinol Laryngol 93(5.1):430–437PubMedGoogle Scholar
  11. 11.
    Marple BF (1999) Ludwig angina: A review of current airway management. Arch Otolaryngol and Head Neck Surg 125:596–599Google Scholar
  12. 12.
    Adeloye A, Singh SP, Odeku EL (1970) Stridor, myelomeningocele, and hydrocephalus in a child. Arch Neurol 23:271–273PubMedGoogle Scholar
  13. 13.
    Rath GP, Bithal PK, Chaturvedi A (2006) Atypical presentations in chiari II malformation. Pediatr Neurosur 42:379–382CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2010

Authors and Affiliations

  • M. Panduranga Kamath
    • 1
  • Mahesh Chandra Hegde
    • 1
  • Suja Sreedharan
    • 1
  • Kiran Bhojwani
    • 1
  • Vandana Vamadevan
    • 1
  • K. V. Vishwas
    • 1
  1. 1.Department of OtorhinolaryngologyKasturba Medical CollegeMangaloreIndia

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