Postextubation stridor in paediatric cardiac surgery patients

Abstract

Background: Paediatric patients undergoing cardiac surgery are likely to be prone to developing postextubation stridor (PES) due to their airway anatomy and several factors related to surgery, Aim: To examine the incidence and risk factors for PES in paediatric patients undergoing cardiac surgery. Methods: The study was prospectively conducted in the paediatric cardiac postsurgical ICU (PICU) at a tertiary referral hospital from November 2010 to January 2012. All paediatric patients presenting with immediate stridor or its developing within 24 hours after extubation were included. Only those patients who were ventilated for at least 6 hours after surgery, but not more than 7 days and deemed fit for elective extubation were considered. Results: Of the 1328 patients admitted to the PICU, 29 patients (2.18%) met the criteria for PES. Of these, 22 (75.6%) were < 1 year old. Ten patients (34%) did not respond to conservative approach or Noninvasive Ventilation (NIV) and had to be reintubated. Six patients were reintubated within an hour, three in < 6 hours and one after 12 hours of extubation. Conclusion: PES is common in paediatric postcardiac surgical patients. Infants are more prone to develop PES. Majority of them can be successfully managed with conservative measures and noninvasive ventilation. The onset of PES varies from immediately after extubation to 3 hours after extubation. Up to one-third of the patients with PES may require reintubation and is common in the first hour after extubation. Patients who develop PES need close observation in the first few hours after extubation.