Purpose: Prolonged endotracheal intubation may lead to laryngeal damage, with stridor being the most relevant clinical symptom. Our objective was to determine the incidence of post-extubation stridor and their clinical consequences in children within a tertiary referral center and to identify contributing factors. Methods: 150 children, aged 0–16 years, intubated for more than 24 h were prospectively enrolled until discharge of the hospital. Potential relevant factors, thought to mediate the risk of laryngeal damage, were recorded and analyzed. Results: The median duration of intubation was 4 days, ranging from 1 to 31 days. Stridor following extubation occurred in 28 patients (18.7%); 3 of them required reintubation due to respiratory distress and in 1 child stridor persisted for which a surgical intervention was necessary. In multivariate analyses, we found the following independent predictors of stridor: intubation on the scene, the use of cuffed tubes and lower age. Conclusion: Despite a high incidence for post-extubation stridor, only few children need reintubation or surgical intervention as a result of post-extubation lesions. Intubation on the scene, the use of cuffed tubes and young age are associated with a significant increased risk of post-extubation stridor. Awareness of these factors gives the possibility to anticipate on the situation and to minimize laryngeal injury and its possible future consequences.

Additional Metadata
Keywords Complications, Endotracheal tube, Laryngeal damage, Laryngotracheal stenosis, Pediatric airway, Prolonged intubation, Stridor, Subglottic stenosis
Persistent URL dx.doi.org/10.1007/s00405-020-05877-0, hdl.handle.net/1765/125596
Journal European Archives of Oto-Rhino-Laryngology
Citation
Veder, L.L, Joosten, K.F.M, Schlink, K. (K.), Timmerman, M.K, Hoeve, L.J, van der Schroeff, M.P, & Pullens, B. (2020). Post-extubation stridor after prolonged intubation in the pediatric intensive care unit (PICU): a prospective observational cohort study. European Archives of Oto-Rhino-Laryngology. doi:10.1007/s00405-020-05877-0