tetano
Editor, Senior Moderator
Respir Care
. 2022 Mar 22;respcare.09527.
doi: 10.4187/respcare.09527. Online ahead of print.
Postextubation Stridor in Severe COVID-19
Georges Abi Abdallah[SUP] 1 [/SUP], Alexis Ferré[SUP] 1 [/SUP], Antoine Gros[SUP] 1 [/SUP], Christelle Simon[SUP] 1 [/SUP], Fabrice Bruneel[SUP] 1 [/SUP], Stéphanie Marque-Juillet[SUP] 2 [/SUP], Stéphane Legriel[SUP] 3 [/SUP], Marine Paul[SUP] 4 [/SUP]
Affiliations
Abstract
Background: During the coronavirus disease 2019 (COVID-19) pandemic, 60-80% of patients admitted to ICU require mechanical ventilation for respiratory distress. We aimed to compare the frequency of postextubation stridor (PES) and to explore risk factors in COVID-19 subjects compared to those without COVID-19.
Methods: We performed an observational retrospective study on subjects admitted for severe COVID-19 requiring mechanical ventilation > 48 h during the first and second waves in 2020 and compared these subjects to historical controls without COVID-19 who received mechanical ventilation > 48 h between 2016-2019. The primary outcome was the frequency of PES, defined as audible stridor within 2 h following extubation.
Results: Of the 134 subjects admitted with severe COVID-19 requiring mechanical ventilation, 96 were extubated and included and compared to 211 controls. The frequency of PES was 22.9% in the COVID-19 subjects and 3.8% in the controls (P < .001). Factors independently associated with PES were having COVID-19 (odds ratio 3.72, [95% CI 1.24-12.14], P = .02), female sex (odds ratio 5.77 [95% CI 2.30-15.64], P < .001), and tube mobilization or re-intubation or prone positioning (odds ratio 3.01 [95% CI 1.04-9.44], P = .047) after adjustment on Simplified Acute Physiology Score II expanded). During the first wave, PES was significantly more common in subjects with a positive SARS-CoV-2 RT-PCR test on tracheal samples on the day of extubation (73.3% vs 24.3%, P = .018).
Conclusions: PES affected nearly one-quarter of subjects with COVID-19, a proportion significantly higher than that seen in controls. Independent risk factors for PES were COVID-19, female sex, and tube mobilization or re-intubation or prone positioning. PES was associated with persistent viral shedding at the time of extubation.
Keywords: COVID-19; SARS-CoV-2; postextubation laryngeal edema; postextubation stridor; viral load.
. 2022 Mar 22;respcare.09527.
doi: 10.4187/respcare.09527. Online ahead of print.
Postextubation Stridor in Severe COVID-19
Georges Abi Abdallah[SUP] 1 [/SUP], Alexis Ferré[SUP] 1 [/SUP], Antoine Gros[SUP] 1 [/SUP], Christelle Simon[SUP] 1 [/SUP], Fabrice Bruneel[SUP] 1 [/SUP], Stéphanie Marque-Juillet[SUP] 2 [/SUP], Stéphane Legriel[SUP] 3 [/SUP], Marine Paul[SUP] 4 [/SUP]
Affiliations
- PMID: 35318237
- DOI: 10.4187/respcare.09527
Abstract
Background: During the coronavirus disease 2019 (COVID-19) pandemic, 60-80% of patients admitted to ICU require mechanical ventilation for respiratory distress. We aimed to compare the frequency of postextubation stridor (PES) and to explore risk factors in COVID-19 subjects compared to those without COVID-19.
Methods: We performed an observational retrospective study on subjects admitted for severe COVID-19 requiring mechanical ventilation > 48 h during the first and second waves in 2020 and compared these subjects to historical controls without COVID-19 who received mechanical ventilation > 48 h between 2016-2019. The primary outcome was the frequency of PES, defined as audible stridor within 2 h following extubation.
Results: Of the 134 subjects admitted with severe COVID-19 requiring mechanical ventilation, 96 were extubated and included and compared to 211 controls. The frequency of PES was 22.9% in the COVID-19 subjects and 3.8% in the controls (P < .001). Factors independently associated with PES were having COVID-19 (odds ratio 3.72, [95% CI 1.24-12.14], P = .02), female sex (odds ratio 5.77 [95% CI 2.30-15.64], P < .001), and tube mobilization or re-intubation or prone positioning (odds ratio 3.01 [95% CI 1.04-9.44], P = .047) after adjustment on Simplified Acute Physiology Score II expanded). During the first wave, PES was significantly more common in subjects with a positive SARS-CoV-2 RT-PCR test on tracheal samples on the day of extubation (73.3% vs 24.3%, P = .018).
Conclusions: PES affected nearly one-quarter of subjects with COVID-19, a proportion significantly higher than that seen in controls. Independent risk factors for PES were COVID-19, female sex, and tube mobilization or re-intubation or prone positioning. PES was associated with persistent viral shedding at the time of extubation.
Keywords: COVID-19; SARS-CoV-2; postextubation laryngeal edema; postextubation stridor; viral load.