Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study

Abstract

The cuff-leak test was widely used for the prediction of post-extubation stridor, but controversial results limit its clinical application. The current study used real-time ultrasonography to evaluate the air-leak and hypothesised that the air-column width, measured by ultrasonography, may be correlated to the development of post-extubation stridor.From June 1, 2001 to March 1, 2002, a total of 51 planned extubations in 51 consecutively intubated patients were included. All of the patients received ultrasonographical examinations of their vocal cords and larynx in addition to an air-column width measurement within 24 h prior to extubation.The overall post-extubation stridor rate was 7.8%. The air-leak volume presented as median (interquartile range) were 300 (350) mL and 25 (20) mL, respectively, for the nonstridor and stridor groups. The air-column width during cuff deflation was 6.4 (2) mm and 4.5 (0.8) mm, respectively. They were found to be statistically significant.In conclusion, the authors demonstrated that laryngeal ultrasonography could be a reliable, noninvasive method, in the evaluation of vocal cords, laryngeal morphology and the ease of airflow, which passed through vocal cords or subglottic area due to laryngeal oedema. The aircolumn width during cuff deflation was a potential predictor of post-extubation stridor.

Applications of Ultrasonography in ENT: Airway Assessment and Nerve Blockade

“…In an effort to overcome the limitations of the cuff-leak test, the ability of ultrasonography to predict postextubation stridor has been evaluated by using ultrasound-measured air-column widths. 30 In a study of 51 consecutive planned extubations, the air-leak volume (300 vs 25 mL) and air-column widths (6.4 vs 4.5 mm) were significantly less in patients with stridor (rate of 7.8%). These investigators placed the ultrasound probe transversely on the cricothyroid membrane while the patient's balloon cuff was both inflated and deflated.…”

Analytic Study of Severe and/or Frequent Situations in the Critically Ill

“…− Vocal cord edema, laryngeal edema are sources of − post-extubation dramas (stridor). Stridor can complicate from 2% to 15% of extubations [27]. The cuffleak test has good negative predictive value but poor In patients who are too slender, for teams who have no vascular probe, some cheap tofu will create adequate acoustic interposition positive predictive value The ultrasound air-column width measurement should identify high-risk patients.…”

Postextubation management of patients at high risk for reintubation

“…Studies comparing high flow nasal cannula oxygen delivery and conventional oxygen with face masks should also evaluate laryngeal function. This might be accomplished by voice assessment and ultrasound measurements (14)(15)(16). The termination of high flow nasal cannula oxygenation support should be based on clinical parameters and not arbitrary time limits.…”