Presence Of Stridor Research Articles

Case report on tracheo-bronchial Stenting: A Rare procedure

In the expanding era of interventional medicine, tracheo-bronchial stenting has emerged as an exigent procedure with new ray of hope. The most common indications for stenting are to minimise extrinsic airway compression from mass effect, maintain airway patency due to intrinsic obstruction or treat significant nonmalignant airway narrowing or fistula. It plays an important role as a bridge to additional tumor-specific therapies, especially in chemoradiotherapy-naïve patients. Our patient, a 66-year-old lady with history of recurrent oesphageal carcinoma treated with chemotherapy, was suffering from increasing breathlessness with presence of stridor. Tracheo-bronchial stenting (Y-stenting) was done successfully in this patient to relieve her tracheal stenosis as observed in bronchoscopy. We report this case as it highlights the first ever Y-stenting in Bangladesh, might cultivate more feasibilty towards such intervention in different centres. Bangladesh J Medicine 2024; 35: 218-220

FOREIGN BODY ASPIRATION IN CHILDREN: CLINICAL, RADIOLOGICAL AND BRONCHOSCOPY FINDINGS

Background: Foreign body aspiration (FBA) is a serious problem that leads to partial or complete airway obstruction. Respiratory distress and pneumonia are the most common complications. The assortment of foreign bodies is very wide. The most common include candy, fish bones, peanuts and nuts, toys, food and batteries. Aim of this study was to determine how accurate the presenting symptoms and signs of foreign body aspiration are and to assess the radiologic findings, the types and sites of the foreign bodies removed. Patients and Methods: a retrospective study included101 patient from age of one month to 15 years with suspected foreign body aspiration based on history, clinical examination, Chest Xray. Rigid bronchoscopy was done for patients under general anaesthesia with muscle relaxation using neuromuscular blocking agents. For every patient gender, age, residence, interval between event and symptom onset, symptoms at admission, signs of respiratory insufficiency, pulmonary auscultation findings, Chest X-ray findings, interval between admission and bronchoscopy, the location of foreign body, type of foreign body, hospitalization days were studied and statistically analysed. A p-value of < 0.05 was considered statistically significant. Results: Seventy six (75.24%) were proved to have foreign body aspiration that was removed by rigid bronchoscopy. toddler was the common age group 43(42.6%). Male were affected more than females 1.2:1. A significantly higher percentage of patients who had a foreign body were witnessed by a family member than those who did not have a foreign body 61.8% vs 0% (p=0.001). Stridor and cough with breathlessness were the most common signs and symptoms while unilateral wheezes, crepitations and diminished air entry were less frequent while each of crepitations, unilateral wheezes and cough with breathlessness were significantly associated with foreign body aspiration (p=0.001, 0.001, 0.02 respectively). Abnormal chest X ray finding was significantly associated with FBA (p=0.02) with hyperinflation being the most frequent finding. The types of foreign bodies removed were sunflower seeds (27.6%), food particles (18.4%) and nuts (17.1%). The most common site of foreign body was the right main bronchus (52.6%) followed by left main bronchus (34.2%). There is a significant association between foreign body aspiration and the time interval between admission and bronchoscopy but no significant relation with age, interval between the event and onset of symptoms and hospitalization days. Conclusion: The history of being witnessed by a family member, the presence of stridor and cough and finding of unilateral wheezes and crepitations on examination as well as hyperinflation on chest X ray are significantly associated with FBA. The sunflower seeds and food particles are the most common types and the right main bronchus is the main site of foreign bodies removed by bronchoscopy.

A Rare Mechanical Cause of Extubation Failure After Short-Term Intubation and Outgoing with the Stridor Clinic: Obstructive Fibrinous Tracheal Pseudomembrane : A CASE REPORT

Stridor after extubation is generally a clinical symptom that may indicate laryngeal edema or vocal cord injury due to intubation, and hoarseness may accompany this.The presence of stridor may cause reintubation due to upper airway obstruction, a risk factor for patient mortality and morbidity.Laryngeal edema and vocal cord damage are mostly seen as the cause of stridor.In this case, OFTP (Obstructive fibrinous tracheal pseudomembrane) and stridor in the lower line of the vocal cords, which are rarely seen during short-term intubation, are presented.

Predictors of Survival in Atypical Parkinsonian Syndromes in a Tunisian Cohort (P8-11.006)

<h3>Objective:</h3> Our aim was to investigate demographic, clinical and genetic survival factors in a Tunisian cohort with atypical parkinsonian syndromes (APS). <h3>Background:</h3> APS encompass a spectrum of neurodegenerative diseases including dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal syndrome (CBS), all characterized by faster progression and earlier mortality compared to Parkinson’s disease. However, the predictors of survival are still controversial. <h3>Design/Methods:</h3> We conducted a retrospective study over a period of 19 years (2003–2021) in the Department of Neurology of Razi University Hospital, in Tunis, Tunisia, including patients diagnosed with APS. Survival was explored using Kaplan-Meier analysis. Demographic, clinical, neuropsychological features and frequency of Apolipoprotein Epsilon 4 (ApoEɛ4) allele were analyzed in the survival analysis. <h3>Results:</h3> We included 340 APS patients (151 DLB, 74 PSP, 70 MSA, 45 CBS). Median survival was 6 years from disease onset in DLB and MSA and 7 years in PSP and CBS. It was significantly shorter for men (p=0.005) and for patients with memory symptoms at onset (p=0.040) in DLB, later age of onset (&gt;65 years, p=0.021), earlier dysphagia and ApoEɛ4 allele carrying status in PSP patients. In MSA, median survival was shorter in parkinsonian subtype (MSA-P) compared to cerebellar subtype (MSA-C) in patients having urinary dysfunction. Although the presence of stridor was associated with shorter survival (6 vs 9 years), the difference was not statistically significant (p=0.090). In CBS, the presence of alien limb syndrome (p=0.031), dementia (p=0.026) and tremor-dominant parkinsonian syndrome (p=0.019) were associated with shorter survival. <h3>Conclusions:</h3> Our results showed shorter survival in synucleinopathies compared to tauopathies with different predictive demographic and clinical factors across APS. ApoEɛ4 seemed to have an effect only in PSP. Larger prospective studies are needed to better investigate the various survival determinants. <b>Disclosure:</b> Dr. Nasri has nothing to disclose. Ikram Sghaier has nothing to disclose. Mrabet Saloua has nothing to disclose. Mr. Abida has nothing to disclose. Alya GHARBI has nothing to disclose. Amira Souissi has nothing to disclose. Mouna BenDjebara has nothing to disclose. Amina Gargouri has nothing to disclose. Dr. Kacem has nothing to disclose. Dr. Gouider has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Gouider has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Gouider has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Gouider has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. The institution of Dr. Gouider has received research support from Clinical Investigation Center. The institution of Dr. Gouider has received research support from Menactrims.

Surgical Candidacy for Management of Laryngomalacia: A Proposed Scoring System.

Identifying surgical candidacy for the management of laryngomalacia is a challenge. To develop a simple scoring system for surgical candidacy in laryngomalacia. Eighteen years retrospective observational study of children with laryngomalacia (LM) clinically categorized into mild, moderate and severe LM and were analyzed for surgical candidacy. There were 113 children (age ranging from 5days to 14months), 44% being mild, 30% moderate and 26% severe LM. None in mild, 32% in moderate, and all in severe LM had surgical intervention. Presence of stridor on feeding or crying and isolated type 1 or type 2 LM on laryngoscopy were significant indicators for conservative treatment (p-< 0.0001). Moderate failure to thrive, retraction at rest/sleep, with low oxygen saturation while feeding/at rest were significantly higher in both moderate and severe groups with laryngoscopic evidence of combined type 1 and 2 in moderate LM (p < 00,001). Aspiration pneumonia, hospitalization, pectus and mean pulmonary arterial pressure of more than 25mmHg with laryngoscopic findings of all three combined types were significantly higher in severe LM (p < 0.0001).A simple scoring system was then developed and it revealed that a score of 10 or more required surgical intervention. A clinical scoring system is being reported for the first time in medical literature to identify 'the difficult to treat' subset within moderate laryngomalacia category simplifying decision making in its management for otolaryngologists and pediatricians as well as a referral criterion for pediatric otolaryngologists' services.

Assessment, diagnosis and treatment of children who present with stridor.

The presence of stridor in children signifies a partial obstruction in the upper airways, the cause of which may range from mild to life-threatening depending on aetiology. The most common causes of stridor in this population are laryngotracheobronchitis (viral croup) and foreign body aspiration. This article gives an overview of the signs, symptoms and potential causes of stridor and the signs and symptoms of, and diagnostic criteria for, viral croup. The author also discusses evidence-based assessment criteria and treatments and criteria for admission or discharge. A case study is used for illustration.

Multicenter randomized clinical trial comparing dexamethasone versus placebo in preventing upper airway obstruction after extubation in critically ill children

To analyze the effectiveness of dexamethasone in preventing upper airway obstruction (UAO) symptoms after extubation and the need of reintubation in critically ill children. Multicenter, prospective, double-blind, randomized, phase IV clinical trial involving five pediatric intensive care units. Children between 1 month and 16 years-of-age intubated for more than 48 h were included. Patients were randomized to receive placebo or dexamethasone 0.25 mg/kg every 6 h, 6-to-12 h prior to extubation (four doses). 48 h follow-up was carried out after extubation. Severity of UAO symptoms (Taussig score, stridor) and reintubation requirement were compared. 147 patients were randomized (10 were excluded), 70 patients received dexamethasone and 67 placebo. No global differences were found in the presence of stridor or moderate-to-severe UAO symptoms (Taussig ≥ 5), but Taussig ≥ 5 was less frequent in patients less than 2 years-of-age treated with steroids (p = 0.014). Median Taussig score was lower in the dexamethasone group 1 h after extubation, p < 0.001. 27 patients required reintubation, 9 due to UAO: 3 (4.3%) in the dexamethasone group and 6 (8.9%) in the placebo group, p = 0.319. In those intubated > 5 days, reintubation due to UAO was higher in the placebo group (2.4% vs. 14.3, p = 0.052). Nebulized epinephrine and budesonide were required more frequently in the placebo group in the first 2 h (p = 0.041) and 1 h (p = 0.02) after extubation, respectively. No relevant side effects were observed. Dexamethasone prior to extubation did not significantly reduce moderate-severe UAO symptoms, except for patients under 2-years of age. Dexamethasone could decrease Taussig score and the need of rescue therapies, as well as reintubation rates in those intubated for more than 5 days.

Stridor After Tracheoesophageal Fistula Repair: Where Is the Lesion?

Stridor After Tracheoesophageal Fistula Repair: Where Is the Lesion?

Extubation Failure: The reality of a Pediatric Intensive Care Unit

Extubation failure (EF) is characterized by the need for reintubation after removal of the endotracheal tube. The prevalence in pediatric age is estimated at 2-20%. Although the causes are almost always multifactorial, EF has been associated with several risk factors and is generally associated with a worse prognosis and higher morbidity. We aimed to characterize the patients with EF admitted to the Pediatric Intensive Care Unit (PICU) of a Tertiary Hospital. It was performed a retrospective descriptive study of EF cases, considering all children admitted to the PICU between January 2017 and June 2020. Our study showed that patients with EF are mostly male and under the age of 2 years, with surgical admission, congenital heart disease, a higher LOS in PICU (12.5 days vs 5.6 days) and mortality (9.0% vs 2.67%). The presence of stridor was more prevalent in EF patients (45.4% vs 8.9%), probably increasing the risk of EF. Peri-extubation corticosteroids used in 72.7% of the EF patients seem to justify in part the existence of stridor after extubation (10.3% of all extubated patients vs 45.4% in EF patients). The higher use of corticosteroids in EF patients (72.7% vs 57.5%) is in line with higher stridor incidence among EF patients. Patients with EF have a higher length of stay, more comorbidities, more sequelae and generally worse prognosis. The adequate characterization of these patients makes it possible to plan and develop multidisciplinary strategies to prevent and minimize the risk factors associated with EF.

Prevalence of extubation and associated risk factors at a tertiary care pediatric intensive care unit.

Extubation failure (EF) is associated with a higher risk for pneumonia, hospital stay, and mortality. To determine the prevalence of EF and identify the associated factors in our population. Observational and retrospective design. All patients aged 1 month old to 18 years old who required mechanical ventilation for more than 12 hours and underwent at least one scheduled extubation during their stay in the 2012-2016 period were included. The aspects related to ventilation and the causes of failure were recorded. Seven hundred and thirty-one patients were extubated and the prevalence of EF was 19.3 %. The causes of failure included upper airway obstruction (51.4 %), muscle fatigue (20.1 %), respiratory center depression (14.6 %), and inability to protect the airways (9.7 %). As per the multivariate analysis, the independent factors that accounted for EF were neurological complex chronic condition (odds ratio [OR] = 2.27; 95 % confidence interval [CI] = 1.21-4.26); acute lower respiratory tract infection in a patient with prior sequelae (OR = 1.87, 95 % CI = 1.113.15); acute neurological injury (OR = 1.92, 95 % CI = 1.03-3.57); unplanned extubation (OR = 2.52, 95 % CI = 1.02-6.21), and presence of stridor (OR = 5.84, 95 % CI = 3.66-9.31). The main cause of EF was upper airway obstruction. Neurological sequelae, acute neurological injury, unplanned extubation, and the presence of postextubation stridor were identified as risk factors associated with EF.

Exposures to Single-Use Detergent Sacs Reported to a Statewide Poison Control System, 2013-2015.

Single-use detergent sacs (SUDSs) represent a relatively new household hazard to children. Brand differences and packaging changes may contribute to differential risks with accidental exposure. We sought to identify high-risk features from SUDS exposures in children and to assess whether product packaging changed trends in SUDS exposures reported to poison centers. In this institutional review board-approved, retrospective chart review of SUDS exposures from January 2013 to August 2015, deidentified case records of a large statewide poison control system were extracted and analyzed for clinical associations and trends. Clinical and demographic data were gathered, and outcomes were analyzed for differences by brand type, presenting complaints, and occurrence in relation to SUDS packaging changes. There were 3502 SUDS exposures, with 3343 (95%) in children 5 years or younger. Metabolic, central nervous system, and pulmonary effects were significantly associated with moderate or severe outcome (P < 0.05). Forty patients received invasive procedures such as endoscopy, bronchoscopy, and/or endotracheal intubation, and more than half had mucosal lesions discovered by the diagnostic procedure. The presence of stridor, wheezing, drooling, lethargy, and exposure to the brand All Mighty Pacs were all significant predictors of moderate or severe outcome (P < 0.05). After the implementation of packaging changes, there was a transient decline in the number of exposures to the Tide Pods product. Central nervous system and respiratory effects as well as certain brand types predict serious outcomes from SUDS exposures. Manufacturing changes had a brief beneficial effect on the volume of SUDS exposures reported between 2013 and 2015.

Do selective serotonin reuptake inhibitors improve survival in multiple system atrophy?

IntroductionLoss of brainstem serotonergic neurons in MSA patients is implicated in respiratory dysfunction including stridor and may increase the risk of sudden death. Augmenting serotonergic transmission through selective serotonergic reuptake inhibitors (SSRIs) has been proposed to improve stridor and prolong survival in multiple system atrophy (MSA). We sought to determine whether MSA patients on an SSRI during their disease course have improved survival compared to those not on an SSRI. MethodsReview of all MSA patients from 1998 to 2012 at Mayo Clinic, Rochester who completed autonomic function testing. Use of SSRI medications was obtained from patient-provided medication lists in the electronic medical record. Clinical symptoms were collected from patient histories; the presence of stridor was obtained from clinical histories and polysomnogram. Surviving patients were called to assess for stridor and SSRI use. ResultsOf 685 MSA patients, 132 (19%) were on an SSRI. Median time from symptom onset to death was 7.5 years with no difference based on SSRI use (p = .957). Rates of stridor were similar in SSRI users and non-users based on patient report and polysomnography (p = .494 and p = .181, respectively). SSRI use was associated with parkinsonism (p = .027) and falls (p = .002). Stridor was similar in SSRI users and those not on an SSRI. ConclusionsThere was no difference in survival in MSA patients on an SSRI. However, SSRI use was associated with higher rates of parkinsonism and falls.

Specific patterns of laryngeal electromyography during wakefulness are associated to sleep disordered breathing and nocturnal stridor in multiple system atrophy

BackgroundNocturnal stridor and respiratory abnormalities are important features of multiple system atrophy (MSA) with relevance to patient survival, and they are detected and evaluated mainly through video-polysomnography (video-PSG). Diurnal laryngoscopy seems to yield abnormal findings only in the presence of significant vocal cord (VC) dysfunction. AimTo assess whether specific electrophysiological patterns of diurnal EMG of VC muscles may indicate nocturnal stridor or respiratory dysfunctions in MSA patients. Materials and methodsSeventeen patients with probable MSA were examined. A full-night video-PSG to collect standard breathing parameters (apnea/hypopnea index, mean HbSAO2, oxygen desaturation index, total sleep time with HbSaO2 below 90%) was performed in all the patients. Laryngoscopy and EMG investigation of adductor (thyroarytenoid-TA) and abductor (posterior cricoarytenoid-PCA) muscles of the VCs were also performed. ResultsBoth the laryngeal EMG abnormalities (based on MUAP analysis and kinesiologic EMG investigation of VC muscles) and the laryngoscopic alterations correlated with video-PSG respiratory abnormalities. Specific patterns of EMG findings were consistently found in MSA subjects with nocturnal stridor detected at PSG. In particular, the following EMG findings were related to the severity of breathing abnormalities and the presence of stridor on video-PSG: neurogenic pattern on MUAP analysis of the PCA, paradoxical activation of the TA during inspiration and tonic EMG activity of the TA during quiet breathing. ConclusionsElectromyographic/kinesiologic investigation of VC muscles during wakefulness provides additional information on the pathophysiology of the respiratory abnormalities in MSA patients that could be useful for guiding the choice of the best appropriate treatment and care.

Bronchoscopic Management of Patients With Symptomatic Airway Stenosis and Prognostic Factors for Survival

Interventional bronchoscopy is effective in the management of patients with symptomatic airway obstruction for both malignant and benign conditions. The main aim of this study is to report our experience with emergency interventional bronchoscopy in patients with symptomatic airway obstruction and identify prognostic factors for survival. This is a retrospective observational study of patients undergoing emergency interventional bronchoscopy over a 4-year period. Survival times were analyzed separately for patients with benign and malignant airway obstruction by the Kaplan-Meier method. Between June 2009 and July 2013, 168 emergency interventional bronchoscopies were performed in 112 patients for airway obstruction. The median age was 63 years (range, 20 to 86), and 91 patients (54%) patients were female. Seventy-two cases (43%) had airway obstruction due to malignant disease. There were 3 in-hospital deaths (2.7%). Median survival of the study population was 5.6 months (range, 0 to 51) with a median follow-up of 7.3 months (range, 0 to 51). Median survival for patients with malignant airway obstruction was 3.5 months (range, 0 to 21), and 9.8 months (range, 0.1 to 51) for those with benign disease. Airway intervention facilitated palliative chemotherapy in 32 patients (44%) of those with malignant airway obstruction. At multivariate analysis in patients with malignant airway obstruction, presence of stridor (hazard ratio 1.919, 95% confidence interval: 1.082 to 3.404, p = 0.026) and not receiving postprocedure chemotherapy (hazard ratio 2.05, 95% confidence interval: 1.156 to 3.636, p = 0.014) were independent prognostic factors for death. Emergency interventional bronchoscopy for airway obstruction is safe, relieved symptoms, and facilitated palliative chemotherapy, which improved survival.

Viral croup: Diagnosis and a treatment algorithm

Viral croup is a frequent disease in early childhood. Although it is usually self-limited, it may occasionally become life-threatening. Mild croup is characterized by the presence of stridor without intercostal retractions, whereas moderate-to-severe croup is accompanied by increased work of breathing. A single dose of orally administered dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment with addition of nebulized epinephrine only in cases of moderate-to-severe croup. Nebulized budesonide (2 mg) can be given alternatively to children who do not tolerate oral dexamethasone. Exposure to cold air or administration of cool mist are treatment interventions for viral croup that are not supported by published evidence, but breathing heliox can potentially reduce the work of breathing related to upper airway obstruction. In summary, corticosteroids may decrease the intensity of viral croup symptoms irrespective to their severity on presentation to the emergency department.

Vocal fold motion impairment in multiple system atrophy

Multiple system atrophy (MSA) is a degenerative neurologic disorder that can affect vocal fold mobility. Our aim was to further elucidate the impact of vocal fold motion impairment (VFMI) in MSA. Retrospective case series. We undertook a retrospective review of all MSA patients reporting voice or respiratory symptoms from 1975 to 2010 at Mayo Clinic Rochester who also received otolaryngologic examination. Thirty-eight MSA patients demonstrated VFMI. Median duration of vocal or respiratory symptoms prior to diagnosis of MSA was 12.0 months (range, 1-60 months). Stridor was present in 25 (68%) of patients. There was bilateral VFMI in 32 (82.4%) of the patients and isolated VFMI of the left true vocal fold (TVF) in six (17.6%) of the patients. No patients had isolated right VFMI. There was isolated unilateral or bilateral paresis in 21 (55.3%) of the patients and unilateral or bilateral complete paralysis in 15 (39.5%) of the patients. One patient presented with left TVF paralysis and right TVF paresis, whereas one other patient had findings of right TVF paralysis and left TVF paresis comprising the remaining 5.2% of patients with VFMI. The median survival after diagnosis of VFMI was 51.6 months. Unilateral or bilateral TVF paralysis was statistically associated with a decreased overall survival (P = .0384). The presence of stridor was not associated with adverse prognosis. The increasing severity of VFMI negatively impacts overall survival in patients with MSA. Therefore, otolaryngologic examination is warranted at the time of MSA diagnosis.

DOK7 congenital myasthenic syndrome

Despite being a fairly recent discovery, DOK7 congenital myasthenic syndrome (CMS) is the third most common form of CMS in the United Kingdom. DOK7 is a postsynaptic protein associated with the AChR clustering pathway. In contrast to AChR deficiency due to epsilon subunit mutations, onset of DOK7 CMS tends to be later--ages two to three years--and in DOK7 CMS eye movements are usually spared and anticholinesterases can exacerbate the weakness. The typical phenotype of DOK7 CMS is of a limb girdle weakness with associated nonspecific myopathic features. The presence of stridor in early onset cases and the observation of tongue wasting may be specific clues. Worsening in adulthood is common, particularly affecting bulbar and respiratory function. Treatment with ephedrine or oral salbutamol can result in a slow, steady, and often dramatic improvement over months.

Cuff leak tests: analysis of diagnostic accuracy in observational cohorts of patients with acute respiratory failure

Cuff leak tests provide clinicians with information about upper airway narrowing and may help predict weaning success. However, most clinical trials reporting this measurement are small, and the utility of this test remains uncertain. We identified all clinical studies using cuff leak tests in the PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials databases using multiple search terms, including &lt;em&gt;cuff leak test, laryngeal edema, extubation&lt;/em&gt;, and &lt;em&gt;stridor&lt;/em&gt;, and abstracted quantitative information on cuff leaks and outcomes (stridor and reintubation). We reviewed six studies which included 958 patients with acute respiratory failure in intensive care units. Eighty-two patients (8.5%) had postextubation stridor. The weighted mean cuff leak was 119 (&amp;plusmn;51) mls in the patients with stridor and 313 (&amp;plusmn;24) mls in patients without stridor (P&amp;lt;0.01). Sixty-six patients required reintubation. The presence of stridor had a sensitivity of 0.60 (95% CI 0.48-0.72), a specificity of 0.96 (95% CI 0.94-0.97), and a positive likelihood ratio of 13.4 (95% CI 6.9-25.7) for predicting reintubation. No single clinical parameter consistently predicted stridor. Patients with postextubation stridor have smaller cuff leak volumes than patients who do not have stridor and are more likely to require reintubation. Cuff leak measurements can improve decision making with extubation protocols.

Cuff leak tests: analysis of diagnostic accuracy in observational cohorts of patients with acute respiratory failure

Cuff leak tests provide clinicians with information about upper airway narrowing and may help predict weaning success. However, most clinical trials reporting this measurement are small, and the utility of this test remains uncertain. We identified all clinical studies using cuff leak tests in the PubMed, Google Scholar, EMBASE, and Cochrane Central Register of Controlled Trials databases using multiple search terms, including cuff leak test, laryngeal edema, extubation, and stridor, and abstracted quantitative information on cuff leaks and outcomes (stridor and reintubation). We reviewed six studies which included 958 patients with acute respiratory failure in intensive care units. Eighty-two patients (8.5%) had postextubation stridor. The weighted mean cuff leak was 119 (±51) mls in the patients with stridor and 313 (±24) mls in patients without stridor (P&lt;0.01). Sixty-six patients required reintubation. The presence of stridor had a sensitivity of 0.60 (95% CI 0.48-0.72), a specificity of 0.96 (95% CI 0.94-0.97), and a positive likelihood ratio of 13.4 (95% CI 6.9-25.7) for predicting reintubation. No single clinical parameter consistently predicted stridor. Patients with postextubation stridor have smaller cuff leak volumes than patients who do not have stridor and are more likely to require reintubation. Cuff leak measurements can improve decision making with extubation protocols.

Evaluation of respiratory parameters at presentation as clinical indicators of the respiratory localization in dogs and cats with respiratory distress

To describe clinical respiratory parameters in cats and dogs with respiratory distress and identify associations between respiratory signs at presentation and localization of the disease with particular evaluation between the synchrony of abdominal and chest wall movements as a clinical indicators for pleural space disease. Design - Prospective observational clinical study. Emergency service in a university veterinary teaching hospital. Cats and dogs with respiratory distress presented to the emergency service between April 2008 and July 2009. None. The following parameters were systematically determined at time of admission: respiratory rate, heart rate, temperature, type of breathing, movement of the thoracic and abdominal wall during inspiration, presence of stridor, presence and type of dyspnea, and results of thoracic auscultation. Abdominal and chest wall movement was categorized as synchronous, asynchronous, or inverse. Diagnostic test results, diagnosis, and outcome were subsequently recorded. Based on the final diagnoses, animals were assigned to 1 or more of the following groups regarding the anatomical localization of the respiratory distress: upper airways, lower airways, lung parenchyma, pleural space, thoracic wall, nonrespiratory causes, and normal animals. One hundred and seventy-six animals (103 cats and 73 dogs) were evaluated. Inspiratory dyspnea was associated with upper airway disease in dogs and expiratory dyspnea with lower airway disease in cats. Respiratory noises were significantly associated and highly sensitive and specific for upper airway disease. An asynchronous or inverse breathing pattern and decreased lung auscultation results were significantly associated with pleural space disease in both dogs and cats (P<0.001). The combination is highly sensitive (99%) but not very specific (45%). Fast and shallow breathing was not associated with pleural space disease. Increased or moist pulmonary auscultation findings were associated with parenchymal lung disease. Cats and dogs with pleural space disease can be identified by an asynchronous or inverse breathing pattern in combination with decreased lung sounds on auscultation.