High Body Mass Index and Long Duration of Intubation Increase Post-Extubation Stridor in Patients with Mechanical Ventilation

Abstract

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

Cuff‐leak test for predicting postextubation airway complications: a systematic review

“…The average sample size of the included studies was 201, with a range of 49–543. We found that the sample size was not consistent with the number of extubations in four studies (27, 28, 32, 33), suggesting that at least two cuff‐leak tests were performed in the same subject. Participants were tracheally intubated via the oral or nasal route for a length of time ranging from less than 24 hours to several days, and were monitored for about 24 or 48 hours after extubation.…”

“…Our search strategy initially yielded 118 citations ( Figure 1). Of these, 16 unique studies on predicting postextubation airway complications were included in our review; the included studies involved a total of 3172 participants (3218 extubations) (1,7,8,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). In addition, six clinical trials (2500 total patients) on prophylactic administration of steroids (with or without cuff-leak test screening) for preventing postextubation airway complications were identified (20,24,25,(36)(37)(38), as described in our previous review (2).…”

Clinical review: Post-extubation laryngeal edema and extubation failure in critically ill adult patients

“…In general, few studies identified risk factors using multivariate analysis or correction for confounding factors [4,15,19]. Female gender is a risk factor for both laryngeal edema and PES [3,4,6-8,14,25].…”

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“…However, in severe cases reintubation is a must. Laryngeal oedema can be severe enough to prevent the success of re-intubation, in this case emergency tracheostomy is mandatory to save the patient's live [6]. Miller and Cole in 1996 were the first to try to devise test that would aid in predicting PES.…”