Oropharyngeal ultrafast ultrasound measurements in mechanically ventilated critically ill patients do not identify post-extubation stridor

Abstract

Post-extubation stridor is a common complication of endotracheal intubation in ICU. This study aimed to assess whether a series of pre-extubation upper airway ultrasound measurements using shear wave elastography (SWE) could help in detecting post-extubation stridor. A prospective observational study (NCT05611437) was conducted between 2022 and 2024, which consecutively included 150 adults ICU patients intubated for more than 24 h, without prior surgical or neurological upper airway disease nor swallowing disorders. SWE measurements were performed in the 24 h before extubation. The occurrence of post-extubation stridor, dysphonia and swallowing disorders were assessed within 72 h. 125 participants were included in the final analysis. A total of 2,625 ultrasound images were obtained, with 81% deemed interpretable. Post-extubation stridor occurred in 9% of patients and was independently associated with sepsis at admission (OR 8.98; 95%CI 1.3–62.1). No differences were observed between upper airway ultrasound in patients with or without stridor. Stridor was associated with higher rates of dysphonia (82% vs. 23%), swallowing disorders (36% vs. 11%), and extubation failure (46% vs. 10%). Swallowing disorders were independently associated with the duration of mechanical ventilation (OR 1.10; 95% CI 1.04–1.17). Dysphonia was associated with female sex (OR 3.23; 95%CI 1.24–8.37), sternothyroid muscle stiffness (OR 1.11; 95%CI 1.04–1.18), and days of mechanical ventilation (OR 1.09; 95%CI 1.02–1.15). Oropharyngeal SWE is feasible in critically ill patients before extubation, but was not predictive of post-extubation stridor. Further studies are needed to explore its role in predicting post-extubation upper airway complications.