James Schneider1, Unami Mulale2, Stephanie Yamout3, Sharon Pollard4, Peter Silver4. 1. Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, New Hyde Park, NY. Electronic address: jschneide2@nshs.edu. 2. Boston Children's Hospital, Boston, MA. 3. The Permanente Medical Group, Kaiser San Leandro Medical Center, San Leandro, CA. 4. Cohen Children's Medical Center of New York, Hofstra-Northwell School of Medicine, New Hyde Park, NY.
Abstract
PURPOSE: To determine if implementing a protocol maintaining an air leak when using cuffed endotracheal tubes (ETT) throughout the course of mechanical ventilation (MV) in children would decrease the rate of postextubation stridor (PES). METHODS: All children requiring MV through a cuffed ETT were included, except those with (1) upper airway anomaly, (2) died while on MV, (3) received tracheostomy before extubation, and (4) transferred before extubation. We implemented a protocol limiting the volume of air instilled into the cuff, allowing an air leak by 25 cm H2O pressure or by peak inspiratory pressure, whichever was higher. Monitoring occurred every 6 hours, adjusting cuff volumes if necessary. Patients receiving nebulized racemic epinephrine within 24 hours of extubation for upper airway obstruction were defined as having PES. RESULTS: At baseline, 110 patients received cuffed ETTs. The proportion of patients who had an air leak at the time of extubation was 47.3%, and that who developed PES was 21.8%. During the intervention, 101 patients received cuffed ETTs. Most (72.3%) had an air leak at the time of extubation (P< .01), and 9.9% developed PES, a 54.6% relative decrease (relative risk, 0.45; 95% confidence interval, 0.22-0.90; P= .018). CONCLUSIONS: Maintaining an appropriate air leak throughout the course of MV using cuffed ETT decreases the rate of PES in children.
PURPOSE: To determine if implementing a protocol maintaining an air leak when using cuffed endotracheal tubes (ETT) throughout the course of mechanical ventilation (MV) in children would decrease the rate of postextubation stridor (PES). METHODS: All children requiring MV through a cuffed ETT were included, except those with (1) upper airway anomaly, (2) died while on MV, (3) received tracheostomy before extubation, and (4) transferred before extubation. We implemented a protocol limiting the volume of air instilled into the cuff, allowing an air leak by 25 cm H2O pressure or by peak inspiratory pressure, whichever was higher. Monitoring occurred every 6 hours, adjusting cuff volumes if necessary. Patients receiving nebulized racemic epinephrine within 24 hours of extubation for upper airway obstruction were defined as having PES. RESULTS: At baseline, 110 patients received cuffed ETTs. The proportion of patients who had an air leak at the time of extubation was 47.3%, and that who developed PES was 21.8%. During the intervention, 101 patients received cuffed ETTs. Most (72.3%) had an air leak at the time of extubation (P< .01), and 9.9% developed PES, a 54.6% relative decrease (relative risk, 0.45; 95% confidence interval, 0.22-0.90; P= .018). CONCLUSIONS: Maintaining an appropriate air leak throughout the course of MV using cuffed ETT decreases the rate of PES in children.
Authors: Jeremy M Loberger; Caitlin M Campbell; José Colleti; Santiago Borasino; Samer Abu-Sultaneh; Robinder G Khemani Journal: Crit Care Explor Date: 2022-05-27
Authors: Farhan Shaikh; Yeshwanth R Janaapureddy; Shashwat Mohanty; Preetham K Reddy; Kapil Sachane; Parag S Dekate; Anupama Yerra; Dinesh Chirla Journal: Indian J Crit Care Med Date: 2021-02