Extubation failure due to post-extubation stridor is better correlated with neurologic impairment than with upper airway lesions in critically ill pediatric patients

Yaron Harel, Amir Vardi, Raymond Quigley, Lela W. Brink, Scott C. Manning, Thomas J. Carmody, Daniel L. Levin

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

The incidence of post-extubation stridor (PES) in a pediatric intensive care unit (PICU) and the need for reintubation is not known. Predictors of success on a subsequent extubation attempt and the efficacy of dexamethasone treatment prior to a subsequent extubation attempt are not established. In a prospective randomized double blind-controlled study in two PICU's in a university children's hospital setting, of 5,566 admissions over 35-months, we identified 32 patients who failed primary extubation and were reintubated for PES. Twenty-six patients were enrolled in the study and three subsequently excluded. Twelve were randomized to receive dexamethasone and 11 received sodium chloride placebo. Fifteen patients succeeded study extubation and eight failed. Of those receiving dexamethasone, nine patients succeeded and three failed. Of those receiving placebo, six patients succeeded and five failed. There was a poor correlation between anatomical abnormalities of the airway and failure of study extubation. Extubation failure was better correlated with neurologic impairment in the patients. We present a stridor score and demonstrate that it is an excellent predictor of success versus failure for the study extubation. Dexamethasone pre-treatment did not reduce stridor score. We are unable to conclude if dexamethasone pre-treatment reduces extubation failure. We speculate that neurologic impairment leads to extubation failure in critically ill pediatric patients.

Original languageEnglish (US)
Pages (from-to)147-158
Number of pages12
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume39
Issue number2
DOIs
StatePublished - Mar 6 1997

Fingerprint

Respiratory Sounds
Critical Illness
Nervous System
Pediatrics
Dexamethasone
Placebos
Pediatric Intensive Care Units
Double-Blind Method
Sodium Chloride
Incidence
Therapeutics

Keywords

  • corticosteroid
  • extubation
  • mechanical ventilation
  • neurologic impairment
  • pediatric critical care
  • stridor
  • upper airway

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Extubation failure due to post-extubation stridor is better correlated with neurologic impairment than with upper airway lesions in critically ill pediatric patients. / Harel, Yaron; Vardi, Amir; Quigley, Raymond; Brink, Lela W.; Manning, Scott C.; Carmody, Thomas J.; Levin, Daniel L.

In: International Journal of Pediatric Otorhinolaryngology, Vol. 39, No. 2, 06.03.1997, p. 147-158.

Research output: Contribution to journalArticle

@article{39580740b6e14e44a1d53a9e08600565,
title = "Extubation failure due to post-extubation stridor is better correlated with neurologic impairment than with upper airway lesions in critically ill pediatric patients",
abstract = "The incidence of post-extubation stridor (PES) in a pediatric intensive care unit (PICU) and the need for reintubation is not known. Predictors of success on a subsequent extubation attempt and the efficacy of dexamethasone treatment prior to a subsequent extubation attempt are not established. In a prospective randomized double blind-controlled study in two PICU's in a university children's hospital setting, of 5,566 admissions over 35-months, we identified 32 patients who failed primary extubation and were reintubated for PES. Twenty-six patients were enrolled in the study and three subsequently excluded. Twelve were randomized to receive dexamethasone and 11 received sodium chloride placebo. Fifteen patients succeeded study extubation and eight failed. Of those receiving dexamethasone, nine patients succeeded and three failed. Of those receiving placebo, six patients succeeded and five failed. There was a poor correlation between anatomical abnormalities of the airway and failure of study extubation. Extubation failure was better correlated with neurologic impairment in the patients. We present a stridor score and demonstrate that it is an excellent predictor of success versus failure for the study extubation. Dexamethasone pre-treatment did not reduce stridor score. We are unable to conclude if dexamethasone pre-treatment reduces extubation failure. We speculate that neurologic impairment leads to extubation failure in critically ill pediatric patients.",
keywords = "corticosteroid, extubation, mechanical ventilation, neurologic impairment, pediatric critical care, stridor, upper airway",
author = "Yaron Harel and Amir Vardi and Raymond Quigley and Brink, {Lela W.} and Manning, {Scott C.} and Carmody, {Thomas J.} and Levin, {Daniel L.}",
year = "1997",
month = "3",
day = "6",
doi = "10.1016/S0165-5876(97)01488-2",
language = "English (US)",
volume = "39",
pages = "147--158",
journal = "International Journal of Pediatric Otorhinolaryngology",
issn = "0165-5876",
publisher = "Elsevier Ireland Ltd",
number = "2",

}

TY - JOUR

T1 - Extubation failure due to post-extubation stridor is better correlated with neurologic impairment than with upper airway lesions in critically ill pediatric patients

AU - Harel, Yaron

AU - Vardi, Amir

AU - Quigley, Raymond

AU - Brink, Lela W.

AU - Manning, Scott C.

AU - Carmody, Thomas J.

AU - Levin, Daniel L.

PY - 1997/3/6

Y1 - 1997/3/6

N2 - The incidence of post-extubation stridor (PES) in a pediatric intensive care unit (PICU) and the need for reintubation is not known. Predictors of success on a subsequent extubation attempt and the efficacy of dexamethasone treatment prior to a subsequent extubation attempt are not established. In a prospective randomized double blind-controlled study in two PICU's in a university children's hospital setting, of 5,566 admissions over 35-months, we identified 32 patients who failed primary extubation and were reintubated for PES. Twenty-six patients were enrolled in the study and three subsequently excluded. Twelve were randomized to receive dexamethasone and 11 received sodium chloride placebo. Fifteen patients succeeded study extubation and eight failed. Of those receiving dexamethasone, nine patients succeeded and three failed. Of those receiving placebo, six patients succeeded and five failed. There was a poor correlation between anatomical abnormalities of the airway and failure of study extubation. Extubation failure was better correlated with neurologic impairment in the patients. We present a stridor score and demonstrate that it is an excellent predictor of success versus failure for the study extubation. Dexamethasone pre-treatment did not reduce stridor score. We are unable to conclude if dexamethasone pre-treatment reduces extubation failure. We speculate that neurologic impairment leads to extubation failure in critically ill pediatric patients.

AB - The incidence of post-extubation stridor (PES) in a pediatric intensive care unit (PICU) and the need for reintubation is not known. Predictors of success on a subsequent extubation attempt and the efficacy of dexamethasone treatment prior to a subsequent extubation attempt are not established. In a prospective randomized double blind-controlled study in two PICU's in a university children's hospital setting, of 5,566 admissions over 35-months, we identified 32 patients who failed primary extubation and were reintubated for PES. Twenty-six patients were enrolled in the study and three subsequently excluded. Twelve were randomized to receive dexamethasone and 11 received sodium chloride placebo. Fifteen patients succeeded study extubation and eight failed. Of those receiving dexamethasone, nine patients succeeded and three failed. Of those receiving placebo, six patients succeeded and five failed. There was a poor correlation between anatomical abnormalities of the airway and failure of study extubation. Extubation failure was better correlated with neurologic impairment in the patients. We present a stridor score and demonstrate that it is an excellent predictor of success versus failure for the study extubation. Dexamethasone pre-treatment did not reduce stridor score. We are unable to conclude if dexamethasone pre-treatment reduces extubation failure. We speculate that neurologic impairment leads to extubation failure in critically ill pediatric patients.

KW - corticosteroid

KW - extubation

KW - mechanical ventilation

KW - neurologic impairment

KW - pediatric critical care

KW - stridor

KW - upper airway

UR - http://www.scopus.com/inward/record.url?scp=0031555844&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031555844&partnerID=8YFLogxK

U2 - 10.1016/S0165-5876(97)01488-2

DO - 10.1016/S0165-5876(97)01488-2

M3 - Article

VL - 39

SP - 147

EP - 158

JO - International Journal of Pediatric Otorhinolaryngology

JF - International Journal of Pediatric Otorhinolaryngology

SN - 0165-5876

IS - 2

ER -