Ultrasound-guided laryngeal air column width difference and the cuff leak volume in predicting the effectiveness of steroid therapy on postextubation stridor in adult. Are they useful?

Abstract

Objective: To evaluate the effectiveness of steroids therapy on postextubation stridor (PES) depending on the clinical response, the ultrasound guided laryngeal air column width difference (LACWD) and the cuff leak volume (CLV).

Design: Prospective, observer-blinded study.

Setting: Carried out in intensive care unit in Tanta university hospital.

Patients: 432 patients of both sexes received mechanical ventilation for more than 24 hours and met defined criteria for a weaning trial.

Measurements: Ultrasound guided LACWD and CLV were conducted before extubation. Patients developing postextubation stridor were intravenously given 8 mg of dexamethasone every 8 hours for 3 days. The clinical response, ultrasounds guided LACWD and CLV before and after steroid therapy were analyzed. Primary outcome and secondary outcomes of our study were reported.

Results: 387 patients (89.5%) had no PES and 45 patients (10.5%) had PES. Risk factors for PES were longer duration of intubation, younger age and female gender. Both CLV and LACWD showed significant decrease (P< .05) in patients with PES in comparison with no PES patients. 45 patients with PES received dexamethasone treatment; 18 were completely recovered while 27 patients needed reintubation after 1 h. of these 27 patients; 19 patients had successful extubation while 8 patients had tracheostomy. In patients with PES, CLV and LACWD showed significant increase (P< .05) in comparison with before administration. Level of CLV <200 ml and LACWD <0.9 mm carry high sensitivity with high positive predictive value and high accuracy for presence of PES.

Conclusion: Steroids therapy improves postextubation stridor. Both LACWD and CLV are non-invasive and simple methods for monitoring of laryngeal edema regression after steroid therapy. We recommend administration of corticosteroids to patients with a lower level of leak volume and LACWD before extubation.

Keywords: CLV; Dexamethasone; Extubation failure; LACWD; Laryngeal edema; PES.