The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

POST EXTUBATION STRIDOR AND LARYNGEAL EDEMA: AN ORIGINAL STUDY MEASURING THE INCIDENCE, SEVERITY, AND RISK FACTORS

Donald L. Bellerive1, Scott Kopec1, Karen Landry1, Scott Leonard1, Rachel Carragher1, Pam Leclaire1, Luanne Hills1, Paul Alger1, Earl Dyer1, Larry Owens1



Background: Post extubation stridor and laryngeal edema has had traditional explanations and clinical predictions for such conditions. The incidence of such events has been reported to range from 1-5%. Few studies attempt to quantify the frequency, severity or identify risk factors for developing post extubation stridor or larygeal edema.

Methods:
We retrospectively reviewed all consecutive extubations over a four month period of time in 7 adult ICUs both medical and surgical at a major University based academic center. All extubated patients were identified via a data bank of electronic documentation. Patients who developed post extubation stridor or laryngeal edema then had their complete medical record reviewed.

Results:
689 patients were extubated over a 4 month period of time, 5 patients (.0073)developed post extubation larygeal edema and /or stridor, 3 of which were successfully managed with nebulized epinephrine and/or heliox and high flow nasal oxygen while 2 patients required reintubation. Of those 5 patients 3 were post-op CABG pts. intubated with a #8 ETT for the duration of 10hrs each and one with a #8.5 ETT for 8 days. 1 pt. had an intracranial hemorrhage intubated with a #8 ETT for 10 days and reintubated within 24 hrs., with the final pt. a post-op mandibular reconstruction with a #8.5 ETT intubated for 2 days also reintubated within the same time period.

Conclusion:
Persistent interactions between endotracheal intubation and the inflamatory abnormalities of airway remodeling and instability were by our analysies very low and did not present itself to be a prevalent hazard of intubation although some patients did experience life threatening airway complications requiring reintubation. Potential risk factors for the development of post extubation stridor and laryngeal edema certainly difficult to pedict and explain, produced only similarities in tube size yet did lean heavily towards the surgical patient which was unclear given the relatively short time of intubation. Future controlled trials will be needed to answer the airway burden of endotrachial tube placement.