Abstract
ObjectiveTo determine the risk factors associated with stridor, with special attention to the role of the cuffed orotracheal cannula.MethodsProspective analysis of all the intubated patients submitted to mechanical ventilator support from January 2008 to April 2011. The relevant factors for stridor collected were age, weight, size and type of airway tube, diagnosis, and duration of mechanical ventilation. The effects of variables on stridor were evaluated using uni- and multivariate logistic regression models.ResultsA total of 136 patients were included. Mean age was 1.4 year (3 days to 17 years). The mean duration of mechanical ventilation was 73.5 hours. Fifty-six patients (41.2%) presented with stridor after extubation. The total reintubation rate was 19.6% and 12.5 in patients with and without stridor, respectively. The duration of mechanical ventilation (>72 hours) was associated with a greater risk for stridor (odds ratio of 8.60; 95% confidence interval of 2.98-24.82; p<0.001). The presence of the cuffed orotracheal cannula was not associated with stridor (odds ratio of 98; 95% confidence interval of 0.46-2.06; p=0.953).ConclusionThe main risk factor for stridor after extubation in our population was duration of mechanical ventilation. The presence of the cuffed orotracheal cannula was not associated with increased risk for stridor, reinforcing the use of the cuffed orotracheal cannula in children with respiratory distress.
Highlights
The conventional management of severe respiratory distress in children with respiratory failure consists of mechanical ventilation (MV) in the pediatric intensive care unit (PICU)
Some methods have been used to predict post-extubation stridor, such as the air leak test, but the low sensitivity in young children makes the identification of patients at risk troublesome.[4,5] As a result, pediatric intensivists must be aware of all the main risk factors associated with stridor when attending to an intubated child
Our findings show that the duration of MV and the duration of orotracheal cannula (OTC) utilization were the only risk factors associated with stridor after extubation in our population
Summary
The conventional management of severe respiratory distress in children with respiratory failure consists of mechanical ventilation (MV) in the pediatric intensive care unit (PICU). Some methods have been used to predict post-extubation stridor, such as the air leak test, but the low sensitivity in young children makes the identification of patients at risk troublesome.[4,5] As a result, pediatric intensivists must be aware of all the main risk factors associated with stridor when attending to an intubated child. The presence of a cuffed OTC has been traditionally associated with stridor in young children, leading to the classical indication of uncuffed OTC in children under the age of 8 years.[6] in recent years, and after the recommendation of cuffed OTC use in certain circumstances (e.g., poor lung compliance, high airway resistance, or a large glottic air leak) by the American Heart Association,(7) there has been an increasing interest in cuffed tubes in pediatric practice, in the operating room or in the PICU
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