Thu7October1232PM 6
A 68-year-old woman on the intensive care unit is extubated six hours following a Hartmann's procedure. One hour later you are called to assess the patient as the nurse has noted she has developed stridor.
She has a past medical history of chronic stable asthma.
Which one of the following is a recognised risk factor for post-extubation stridor (PES)?
(Please select 1 option)
More than 60 years of age
Low tracheal cuff pressure
Past medical history of asthma Incorrect answer selected
Female gender This is the correct answer
Intubation for less than 24 hours
Explanation
Post-extubation stridor (PES) is a frequent complication of intubation, occurring in 2-16% of cases. It is caused by laryngeal oedema that results from damage to the mucosa of the larynx. Mucosal damage is caused by pressure and ischaemia resulting in an inflammatory response. Laryngeal oedema, in severe cases, can lead to acute respiratory compromise necessitating emergency reintubation.
Female gender is a risk factor for both laryngeal oedema and PES. This predisposition has been hypothesised to be due to the female mucous membrane being less resistant to trauma and thinner than that in men.
Other risk factors include:
Female gender
Intubation >36 hours
Excessive cuff pressure
Large tube size, and
Tracheal infection.
Age and asthma are not known risk factors for PES.
Reference:
Bahal N, Khan M, Manoras A. Get Through: final FRCA: MCQs. London: Hodder & Stoughton; 2011. p 272-272.
Cheng KC, et al. Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients. Crit Care Med. 2006;34:1345-50.
Ho LI, et al. Postextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone. Intensive Care Med. 1996;22:933-6.
Wittekamp BH, et al. Clinical review: post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care. 2009;13:233.
Answer Statistics
1
10%
2
3%
3
35%
4
51%
5
3%
Times answered: 359