Endotracheal intubation is one of the commonest procedures performed in the intensive care unit. Once the requirement of the tube is no longer present and the patient has recovered the ability to maintain airway, clear secretions and has adequate gas exchange, extubation is done. Occasionally, the patients can develop postextubation stridor. This CME article describes the various causes of postextubation stridor, its clinical features, diagnosis and management.
Pluijms WA, van Mook WNKA, Wittekamp BHJ and Bergmans DCJJ. Postextubation laryngeal edema and stridor resulting in respiratory failure in critically ill adult patients: updated review. Critical Care 2015;19:295
Colice GL, Stukel TA, Dain B: Laryngeal complications of prolonged intubation. Chest 1989, 96:877-884.
Darmon JY, Rauss A, Dreyfuss D, et al: Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by desamethasone. Anesthesiology 1992, 77:245-51.
Jaber S, Chanques G, Matecki S, et al: Postextubation stridor in intensive care unit patients. Intensive Care Med 2003, 29:69-74.
Tadie JM, Behm E, Lecuyer L, et al. Postintubation laryngeal injuries and extubation failure: a fiberoptic endoscopic study. Intensive Care Med 2010; 36(6):991-8.
Ding LW, Wang HC, Wu HD, Chang CJ, Yang PC. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study. Eur Respir J 2006;27:384–9.
Miller RL, Cole RP. Association between reduced cuff leak volume and postextubation stridor. Chest 1996;110:1035–40
Wittekamp BH, van Mook WN, Tjan DH, Zwaveling JH, Bergmans DC. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care 2009;13:233
Kemper KJ, Ritz RH, Benson MS, Bishop MS. Helium-oxygen mixture in the treatment of postextubation stridor in pediatric trauma patients. Crit Care Med. 1991;19:356–9.