Post extubation stridor

Post Extubation Stridor Critical Care Grand Rounds April 7, 2008 Janice D Chisholm, BSc, MD, FRCPC

Post Extubation Stridor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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The Cuff Leak Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Miller,RL, Cole, RP. Association between reduced cuff leak volume and postextubation stridor. Chest 1996; 110:1035 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Jaber, S, Chanques, G, Matecki, S, et al. Post-extubation stridor in intensive care unit patients. Risk factors, evaluation and importance of the cuff-leak test. Intensive Care Med 2003; 29:69. ,[object Object],[object Object],[object Object]

Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Risk factors for Developing Post Extubation Stridor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Maury, E, Guglielminotti,J, Alzieu, M, et al. How to identify patients with no risk for postextubation stridor? J Crit Care 2004;19:23 ,[object Object],[object Object],[object Object],[object Object]

Results: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Steroid Prophylaxis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Ho, LI, Harn, HJ, Lien, TC, et al. Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone. Intensive Care Medicine 1996; 22:933 ,[object Object],[object Object],[object Object],[object Object]

Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cheng, KC, Hou, CC, Huang, HC, et al. Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients. Crit Care Med 2006; 34:1345 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Francois, B, Bellissant, E, Desachy, A, et al. 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal edema: a randomised double-blind trial. The Lancet 2007; 369:1083-1089 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Results ,[object Object],[object Object],[object Object],[object Object]

Treatment of Stridor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What do I do now? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object],[object Object]

Post extubation stridor

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Post extubation stridor