From the Guidelines
Stridor is a high-pitched sound that occurs during inhalation or exhalation, often associated with upper airway obstruction, and its management is crucial to prevent post-extubation complications, as suggested by the American Thoracic Society guidelines 1. In the context of mechanical ventilation, stridor can be a significant concern, particularly during extubation. The cuff leak test is a recommended tool to assess the risk of post-extubation stridor, with a high specificity but moderate sensitivity, as reported in a systematic review and meta-analysis 1. Some key points to consider in managing stridor include:
- The use of Heliox, a mixture of helium and oxygen, may be considered in patients with mechanical upper airway obstruction or postoperative stridor, although the evidence is limited and based on case reports and clinical practice 1.
- Protocolized rehabilitation and ventilator liberation protocols can help reduce the risk of post-extubation complications, including stridor, in mechanically ventilated adults 1.
- Systemic steroids may be administered before extubation in patients who have failed the cuff leak test to reduce the risk of post-extubation stridor 1. It is essential to note that the management of stridor should be individualized, taking into account the patient's specific condition, medical history, and response to treatment. The priority should always be to ensure the patient's airway is secure and that they can breathe safely, with the goal of minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Definition and Symptoms of Croup
- Croup is a common respiratory illness affecting children, characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction 2.
- It is often caused by a viral infection, with parainfluenza virus being the most common cause, and typically affects children between 6 months and 3 years of age 2, 3.
- Symptoms of croup include inspiratory stridor, a barking cough, and respiratory distress, which can range from mild to severe 2, 3.
Stridor in Croup
- Stridor is a high-pitched sound that occurs during inhalation, caused by the narrowing of the airway due to swelling of the larynx, trachea, and bronchi 2, 3.
- Inspiratory stridor is a characteristic symptom of croup, and its presence can help differentiate croup from other respiratory illnesses such as acute epiglottitis, bacterial tracheitis, and foreign body airway obstruction 2, 3.
- The severity of stridor can vary, and it is often used as a indicator of the severity of croup, with more severe stridor indicating more severe airway obstruction 2, 3.
Treatment of Croup
- Treatment of croup typically involves the use of corticosteroids, such as dexamethasone, to reduce inflammation and swelling of the airway 4, 2, 5, 3.
- Nebulized epinephrine may also be used to help relieve symptoms in patients with moderate to severe croup 4, 2, 5, 3.
- Heliox, a mixture of helium and oxygen, has been shown to have some benefit in relieving symptoms of croup, particularly in patients with moderate to severe croup 4, 5.