Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study

Abstract The cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Aiko Tanaka, Akinori Uchiyama, Yu Horiguchi, Ryota Higeno, Ryota Sakaguchi, Yukiko Koyama, Hironori Ebishima, Takeshi Yoshida, Atsuhiro Matsumoto, Kanaki Sakai, Daisuke Hiramatsu, Naoya Iguchi, Noriyuki Ohta, Yuji Fujino
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7d08b9812b9b4c99a7ff16a10e73ce99
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:7d08b9812b9b4c99a7ff16a10e73ce99
record_format	dspace
spelling	oai:doaj.org-article:7d08b9812b9b4c99a7ff16a10e73ce992021-12-02T17:13:22ZPredictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study10.1038/s41598-021-99501-82045-2322https://doaj.org/article/7d08b9812b9b4c99a7ff16a10e73ce992021-10-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-99501-8https://doaj.org/toc/2045-2322Abstract The cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5–14] vs. 12 [8–30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01–8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.Aiko TanakaAkinori UchiyamaYu HoriguchiRyota HigenoRyota SakaguchiYukiko KoyamaHironori EbishimaTakeshi YoshidaAtsuhiro MatsumotoKanaki SakaiDaisuke HiramatsuNaoya IguchiNoriyuki OhtaYuji FujinoNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Aiko Tanaka Akinori Uchiyama Yu Horiguchi Ryota Higeno Ryota Sakaguchi Yukiko Koyama Hironori Ebishima Takeshi Yoshida Atsuhiro Matsumoto Kanaki Sakai Daisuke Hiramatsu Naoya Iguchi Noriyuki Ohta Yuji Fujino Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study
description	Abstract The cuff leak test (CLT) has been widely accepted as a simple and noninvasive method for predicting post-extubation stridor (PES). However, its accuracy and clinical impact remain uncertain. We aimed to evaluate the reliability of CLT and to assess the impact of pre-extubation variables on the incidence of PES. A prospective observational study was performed on adult critically ill patients who required mechanical ventilation for more than 24 h. Patients were extubated after the successful spontaneous breathing trial, and CLT was conducted before extubation. Of the 191 patients studied, 26 (13.6%) were deemed positive through CLT. PES developed in 19 patients (9.9%) and resulted in a higher reintubation rate (8.1% vs. 52.6%, p < 0.001) and longer intensive care unit stay (8 [4.5–14] vs. 12 [8–30.5] days, p = 0.01) than patients without PES. The incidence of PES and post-extubation outcomes were similar in patients with both positive and negative CLT results. Compared with patients without PES, patients with PES had longer durations of endotracheal intubation and required endotracheal suctioning more frequently during the 24-h period prior to extubation. After adjusting for confounding factors, frequent endotracheal suctioning more than 15 times per day was associated with an adjusted odds ratio of 2.97 (95% confidence interval, 1.01–8.77) for PES. In conclusion, frequent endotracheal suctioning before extubation was a significant PES predictor in critically ill patients. Further investigations of its impact on the incidence of PES and patient outcomes are warranted.
format	article
author	Aiko Tanaka Akinori Uchiyama Yu Horiguchi Ryota Higeno Ryota Sakaguchi Yukiko Koyama Hironori Ebishima Takeshi Yoshida Atsuhiro Matsumoto Kanaki Sakai Daisuke Hiramatsu Naoya Iguchi Noriyuki Ohta Yuji Fujino
author_facet	Aiko Tanaka Akinori Uchiyama Yu Horiguchi Ryota Higeno Ryota Sakaguchi Yukiko Koyama Hironori Ebishima Takeshi Yoshida Atsuhiro Matsumoto Kanaki Sakai Daisuke Hiramatsu Naoya Iguchi Noriyuki Ohta Yuji Fujino
author_sort	Aiko Tanaka
title	Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study
title_short	Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study
title_full	Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study
title_fullStr	Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study
title_full_unstemmed	Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study
title_sort	predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/7d08b9812b9b4c99a7ff16a10e73ce99
work_keys_str_mv	AT aikotanaka predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT akinoriuchiyama predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT yuhoriguchi predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT ryotahigeno predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT ryotasakaguchi predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT yukikokoyama predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT hironoriebishima predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT takeshiyoshida predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT atsuhiromatsumoto predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT kanakisakai predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT daisukehiramatsu predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT naoyaiguchi predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT noriyukiohta predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy AT yujifujino predictorsofpostextubationstridorinpatientsonmechanicalventilationaprospectiveobservationalstudy
_version_	1718381327341846528

Predictors of post-extubation stridor in patients on mechanical ventilation: a prospective observational study

Ejemplares similares