KOPS Award Abstracts: Trauma and Critical Care

Abstract

Background and Aims:Paediatric trauma patients need prolonged ventilation leading to post-extubation laryngeal oedema and stridor. Air-column width change reflects air leak and airflow around the endotracheal tube and vocal cords. Laryngeal air column width difference and ratio (LACWD and LACWR) are non-invasive methods for predicting the post-extubation stridor (PES).Methods:All children aged 1–14 years admitted to the trauma intensive care unit (TICU) for mechanical ventilation for >24 hours were included over 1 year. For intubated patients, if the size of the endotracheal tube was too large or too small, it was appropriate, whereas with an inappropriate size, the tube was changed. Cuff pressures were monitored and kept at or <20 cm of H2O. Dexamethasone was administered at 0.3 mg/kg/8 hours for 48 hours prior to planned extubation. LACW was measured on the day of receiving in TICU, immediately following intubation, prior to steroid therapy and before extubation. The Cuff leak test was used prior to the start of steroid therapy and before extubation.Results:A total of 50 patients were included, out of which 11 (22%) patients developed PES. Of the total number of patients, seven were intubated in TICU, whereas 43 patients were received intubation from outside. The positive predictive value cut-off of ultra-sound-guided LACWR to diagnose PES was <0.93 with a sensitivity of 90.91 and a specificity of 84.62.Conclusion:Ultra-sound-guided LACWD and LACWR are non-invasive methods of predicting PES in paediatric trauma patients.