Patient height and PES

Q: Which of the following is a risk factor for post-extubation stridor (PES)? - select one

A) High ratio of patient height (in mm) to ETT diameter (in mm)

B) Small ratio of patient height (in mm) to ETT diameter (in mm)

Answer: B

Post-extubation stridor is a common occurrence in the ICU. Various risk factors have been identified. One of the less discussed risk factors is:

A small ratio of patient height (in mm) to ETT diameter (in mm)

Some other well-known factors are:

• Prolonged intubation
• Old age
• Large ETT 
• Elevated APACHE score
• Low GCS score 
• Traumatic intubation
• Female gender
• Previous pulmonary history
• Excessive tube mobility due to insufficient fixation

#ventilators

#pulmonary

#procedures

References:

1. Maury E, Guglielminotti J, Alzieu M, et al. How to identify patients with no risk for postextubation stridor? J Crit Care 2004; 19:23.

2. Wittekamp BH, van Mook WN, Tjan DH, et al. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care 2009; 13:233.

3. Shinohara M, Iwashita M, Abe T, Takeuchi I. Association between post-extubation upper airway obstruction symptoms and airway size measured by computed tomography: a single-center observational study. BMC Emerg Med. 2022 Mar 31;22(1):55. doi: 10.1186/s12873-022-00615-7. PMID: 35361111; PMCID: PMC8974026.

4. Sunil Rathore, Adam Bates, Lawrence Nolan, Trevena Anton, Mckay Jarman, and Gwendolyn Lynch - Neurology - Neurocritical Care: Procedures - Identifying Post-extubation Stridor (PES) Risk Factors in a Neurocritical Care Population (P2-2.002) - April 9, 2024 issue 102 (7_supplement_1) 5689 https://doi.org/10.1212/WNL.0000000000205984