Laryngeal ultrasound as a bedside tool in detecting postextubation stridor in patients with respiratory illness

Context Postextubation stridor is a serious complication in respiratory ICU. Laryngeal ultrasound (US) could be helpful in its diagnosis. Aim The aim was to evaluate accuracy of laryngeal US in detecting postextubation stridor in patients with respiratory illness. Patients and methods A prospective observational study was conducted. A total of 167 mechanically ventilated patients were consequently included over a 2‑year period. Laryngeal US air column width (ACW) was measured just after intubation and at the time of extubation. Air column width ratio (ACWR) (ACW before extubation/ACW after intubation) and air column width difference (ACWD) at the time of extubation (ACW with cuff deflated‑ACW with cuff inflated) were calculated. Statistical analysis Statistical Package for the Social Sciences statistical software computer program version 20 and Medcalc v. 11.6 were used. Nonparametric tests were used. Results Among the included patients, 17 (10.2%) patients developed stridor. Both ACWR and ACED were significantly lower in patients with stridor than those without stridor (0.798 ± 0.051 vs 0.893 ± 0.056, P 0.001; 0.541 ± 0.326 vs 1.237 ± 0.442, P 0.001, respectively). The optimum cutoff value to detect postextubation stridor was less than or equal to 0.86 for ACWR, showing area under the curve of 0.894, 82.4% sensitivity, and 84% specificity and was less than or equal to 0.65 mm for ACWD, showing 76.5% sensitivity, 90% specificity, and area under the curve 0.896. Conclusions US is a valuable tool in detecting postextubation stridor. US ‑ guided ACWR and ACWD could be accurate methods for predicting postextubation stridor in RICU.