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ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 355-361

Predictive value of cuff leak test, laryngeal ultrasound, and fiberoptic laryngoscopy for postextubation stridor after prolonged intubation


Department of Anesthesia and Surgical Intensive Care, Zagazig University, Zagazig, Egypt

Correspondence Address:
MD Farahat I Ahmed
41 Elssehabah Street, Hadayek Alkobbah, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_76_18

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Background Endotracheal intubation is frequently complicated by laryngeal edema, which may present as postextubation stridor (PES) or respiratory difficulty or both. Multiple tests were used to predict the PES. The present study aimed at description and evaluation of the predictive values of the cuff leak test (CLT), laryngeal ultrasound (LUS), and indirect flexible fiberoptic laryngoscopy (FOL) to predict PES in ICU patients after prolonged intubation. Patients and methods This prospective study was conducted on 60 intubated patients who were admitted into the surgical intensive care unit. After successful 30-min spontaneous breathing trial and within 6 h before the planned extubation, CLT, LUS, and FOL were performed for all patients. After extubation, the patients were observed and classified into two groups according to the presence of PES within 48 h. Results Two patients were excluded owing to self-extubation, and 58 patient’s data were analyzed. There was no significant difference in CLT volume and the leak fraction between the patients with PES (PES group) and those without PES (non-PES group). However, statistically, air column width with balloon inflated or deflated was significantly lesser in the PES group than the corresponding values in the non-PES group (P=0.04 and 0.009, respectively). Moreover, there was a high significant difference in the air column width difference between both groups (P<0.001). Moreover, the incidence and severity of laryngeal injuries as per FOL grading scale and the rate of reintubation were statistically higher in the stridor than non-stridor patients group (P<0.001). Conclusion For the noninvasive methods, the CLT has a low predictive value with high possibility of false results, but the data from LUS can be used for approximate evaluation of the laryngeal lumen narrowing; however, the interpretations of the ultrasound data are not conclusive. On the contrary, the FOL is the best accurate diagnostic tool but it is invasive.


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