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Approximately 20% of mechanically ventilated patients experience post-extubation stridor (PES) and reintubation, which subsequently may lead to an increased risk of morbidity and mortality. The risk of PES development is significantly higher in obese patients. Low air leakage between the endotracheal tube and the trachea, following cuff deflation, may indicate a higher risk for the development of PES. The aim of this study is to identify the relationship between body mass index (BMI) and PES using the cuff-leak test in patients intubated in the respiratory intensive care unit. A total of 67 consecutive intubations on 56 different ventilated patients were included in this study. The mean age was 63.6 ± 12.1 years and 84% of the patients were male. PES developed in seven patients (10.4%). The mean cuffleak volume was 395 ± 187 ml in non-PES patients and 240 ± 93 ml in PES patients (p = 0.023). The mean BMI was 36 ± 13 kg/m 2 in PES patients and 24 ± 7 kg/m 2 in non-PES patients (p = 0.046). BMI > 26.5 kg/m 2 (OR: 1.2), low cuff-leak volume (< 283 ml) and mechanical ventilation required for more than 5 days (OR: 0.9) were independent variables for PES occurrence. We therefore suggest that non-obese patients, short-term intubated patients and those having a high air leakage around the endotracheal tube could be extubated without much difficulty.intensive care unit; cuff-leak test; body mass index; post-extubation stridor; reintubation

Amaç: Tüberküloz enfeksiyonunun ortaya çıkan bulgularında basil ile konakçının savunma mekanizmaları arasındaki denge önemlidir. Tüberküloz enfeksiyonunun immünitesinde T lenfositlerin alt grupları kadar aktivasyon durumları da önemlidir. Bu çalışmanın amacı Mikobakterium tüberkülozis enfeksiyonunun farklı klinik formları ile T lenfosit alt grupları, aktivasyonu ve natural killer hücreler arasındaki ilişkinin araştırılmasıdır. Gereç ve Yöntem:Yirmi bir aktif pulmoner tüberküloz, 10 inaktif pulmoner tüberküloz, 10 tüberküloz plörezi hastası ve 18 sağlıklı kontrol olgusu çalışmaya dahil edildi. Periferik kanda immün fenotiplendirme yapılarak T hücre subgrupları, natural killer hücreler ve B hücreler için flowsitometri ve T lenfosit aktivasyonunun gösterilmesi için HLA-DR ve CD25 pozitifliği çalışıldı. Bulgular:Bilateral aktif pulmoner tüberkülozlu hastalarda kontrol grubuna göre CD4+ T lenfosit oranları anlamlı olarak düşük bulundu. Tüberküloz plörezili hastalarda T lenfosit aktivasyonunun artmış olduğu saptandı. CD3/CD25+ T lenfosit yüzdesi tüberküloz plörezili hastalarda hem sağlıklı kontrollere hem de inaktif pulmoner tüberkülozlu olgulara göre istatistiksel anlamlı olarak artmış bulundu. Material and Method: Twenty-one active pulmonary tuberculosis, 10 inactive pulmonary tuberculosis, 10 tuberculous pleurisy patients and 18 healthy subjects were involved in the study.Immunophenotyping was carried out in peripheral blood for T cell subtypes, natural killer cells and B cells by flow-cytometry, and HLA-DR and CD25 positivity were studied to determine T-lymphocyte activation. Results:The CD4+ T lymphocyte rates was found significantly lower in bilateral active pulmonary tuberculosis compared to healthy controls. T-lymphocyte activation was found to be increased in tuberculous pleurisy cases. The CD3/CD25+ T lymphocyte rate was sinificantly higher in tuberculous pleurisy cases compared both to healthy controls and inactive pulmonary tuberculosis cases.Conclusion: CD4+ T-lymphocyte rate may be decreased in pulmonary tuberculosis patients with bilateral pulmonary infiltration. Prominent T-lymphocyte activation in tuberculous pleurisy might be a result of a hypersensitivity reaction against the bacillus. (Tur Toraks Der 2012; 13: 1-5)

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