Persistent Post-Extubation Stridor in an Intensive Care Unit: A Decision Dilemma

Abstract

Stridor is a harsh, wheezing, often high-pitched sound produced by rapid, turbulent fl ow of air through a narrowed supraglottic region to proximal trachea and can be inspiratory, expiratory, or biphasic. 1 The incidence of post-extubation stridor varies from 2 to 42% in pediatric intensive care unit (ICU). 2 Factors like traumatic intubation, multiple attempts, prolonged intubation, use of cuffed or inappropri-ate sized tube, lower age, inadequate analgesia, and sedation are associated with signi fi cant risk of post-extubation stridor. 2,3 Here, we report a case of persistent post-extubation stridor in a patient with traumatic brain injury, who was medically managed, thus avoiding reintubation. Informed consent for reporting this case was obtained from the child ’ s parents. A 2-year-old, 15kg, male child, presented to the emer-gency department with a history of fall from the fi rst fl oor (10 – 12 feet). He was tracheally intubated with a 3.5-mm uncuffed tube in view of low Glasgow Coma Scale (GCS) of E1V2M5. Noncontrast computed tomography (CT) scan of head revealed right basifrontal contusion with fracture of right frontal bone, which was managed conservatively. Ex-tended Focused Assessment of Sonography in Trauma, CT scan of spine and torso, and X-rayof