Post-Extubation Stridor: Likelihood Ratios

Introduction: Laryngeal edema around the ET tube that causes upper airway obstruction when the tube is removed during extubation, thus requiring re-intubation.

Generally it is felt that one should test for an air leak around the ET tube (after deflating the cuff) to indicate that the larynx has not swelled. One can test either by listening with a stethoscope or by looking at the vent monitors.

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Prevalence

The likelihood ratios of findings for Post-Extubation Stridor are listed below. See the left navigation bar to change the display.

Good Positive Likelihood Ratio

Finding	+LR	-LR	Comments, Study
Cuff Leak Test	3.1	0.6	defined by an absolute leak volume < or = 110 mL Other studies have given a range of sensitivity from 15-85% and specificity of 72-99%, e.g. PMID 12528025 and PMID 12209275. However, given the relatively low prevalence (5-12% in the studies cited), the positive predictive value would still be poor and the negative predictive value still rather good. Study: Respir Care. 2005 Dec;50(12):1632-8. PMID 16318644