A comparative study to evaluate the accuracy between cuff leak test & bedside laryngeal ultrasound in predicting post extubation stridor by intensivist- a prospective randomized comparative study

Post-extubation stridor (PES) is the presence of inspiratory noise which develops post-extubation indicating narrowing of the airway with an incidence of 3-30%.[1]PES results in airway obstruction and respiratory distress which further accentuates hemodynamic instability and cardiac failure.[2] Stridor also results in negative pressure pulmonary oedema.[3] Risk Factors associated with PES includes older age, female gender, size of the endotracheal tube, prolonged intubation period, traumatic intubation and multiple intubation attempts. All of these can increase the mortality and morbidity, prolong the length of intensive care unit (ICU) stay and mechanical ventilation.Prior detection of PES prevents the need for reintubation, facilitates early treatment and recovery. The diagnosis of PES is critical as these patients can benefit from attentive monitoring and targeted therapy. Nonetheless, there is no consensus on how to identify patients at risk of PES. Cuff leak test demonstrates leak around the endotracheal tube when the cuff is deflated and is one of the simplest method proposed for predicting the occurrence of post extubation stridor. Ultrasound is bedside noninvasive tool in visualizing upper airway. The Air Column Width Difference predicts the occurrence of post extubation stridor.[4] The lacunae in the previous studies done to predict post extubation stridor had fewer patients in stridor group resulting in lower sensitivity.