Identifying Post-extubation Stridor (PES) Risk Factors in a Neurocritical Care Population
Sunil Rathore1, Adam Bates2, Lawrence Nolan3, Trevena Anton4, Mckay Jarman5, Gwendolyn Lynch6
1Neurology, University Hospitals, 2University Hospitals of Cleveland, 3Sentara Norfolk General, 4Northeast Ohio Medical University, 5School of Medicine, Case Western Reserve University, 6Cleveland Clinic Foundation
Objective:
To identify risk factors for the development of post-extubation stridor in the neurocritical care patient population.
Background:

Post-extubation stridor (PES) is an inadequately studied complication in critically ill patients. Development of PES can result in respiratory failure, requiring the need for emergent re-intubation.  Our understanding of risk factors related to the development of stridor in the neurocritical care population is lacking.  Identification of PES risk factors can contribute to improvement in care in this patient population.   

Design/Methods:

We conducted a retrospective chart review of patients admitted to a neurocritical care unit to determine the demographic, premorbid conditions, admitting diagnoses, and incident treatment risk factors related to development of post-extubation stridor.  We performed a univariate analysis of 130 patients who underwent endotracheal intubation and were admitted to the Neurocritical Care Unit.  We used the Mann-Whitney U Test to evaluate for differences with continuous data, and the Pearson Chi-Square test for differences with categorical data. 

Results:
PES occurred in 6.3% of the study patients who were extubated.  Risk factors for PES include female sex (p<.001) and weight on admission</=65 kg (p=0.036). Patient age, height, premorbid conditions, admitting diagnoses, and incident treatment were not associated with the occurrence of stridor in our study population.  
Conclusions:

In this exploratory analysis risk factors for PES female sex and weight on admission have been identified as risk factors in this neurocritical care population.  An analysis of a larger multicenter patient population with multiple predictors and logistic regression models for clarification of PES risk factors could provide useful insight toward optimizing care in this patient population.

10.1212/WNL.0000000000205984