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Research ArticleOriginal Research

Postextubation Stridor in Severe COVID-19

Georges Abi Abdallah, Alexis Ferré, Antoine Gros, Christelle Simon, Fabrice Bruneel, Stéphanie Marque-Juillet, Stéphane Legriel and Marine Paul
Respiratory Care June 2022, 67 (6) 638-646; DOI: https://doi.org/10.4187/respcare.09527
Georges Abi Abdallah
Medical-Surgical Intensive Care Department Centre Hospitalier de Versailles - Site Andre Mignot, Le Chesnay, France.
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Alexis Ferré
Medical-Surgical Intensive Care Department Centre Hospitalier de Versailles - Site Andre Mignot, Le Chesnay, France.
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Antoine Gros
Medical-Surgical Intensive Care Department Centre Hospitalier de Versailles - Site Andre Mignot, Le Chesnay, France.
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Christelle Simon
Anaesthesia Department Centre Hospitalier de Versailles - Site Andre Mignot, Le Chesnay, France.
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Fabrice Bruneel
Medical-Surgical Intensive Care Department Centre Hospitalier de Versailles - Site Andre Mignot, Le Chesnay, France.
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Stéphanie Marque-Juillet
Microbiology Department, Centre Hospitalier de Versailles - Site Andre Mignot, Le Chesnay, France.
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Stéphane Legriel
Medical-Surgical Intensive Care Department Centre Hospitalier de Versailles - Site Andre Mignot, Le Chesnay, France; and University Paris-Saclay, UVSQ, INSERM, CESP, PsyDev Team, Villejuif, France.
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Marine Paul
Medical-Surgical Intensive Care Department Centre Hospitalier de Versailles - Site Andre Mignot, Le Chesnay, France.
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  • For correspondence: [email protected]
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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.

  • postextubation laryngeal edema
  • postextubation stridor
  • viral load
  • COVID-19
  • SARS-CoV-2

Footnotes

  • Correspondence: Marine Paul MD, Intensive Care Department, Centre Hospitalier de Versailles - Site Andre Mignot, 177 Rue de Versailles, 78150 Le Chesnay, France. E-mail: mpaul{at}ch-versailles.fr
  • See the Related Editorial on Page 772

  • Supplementary material related to this paper is available at http://rc.rcjournal.com.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2022 by Daedalus Enterprises
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Respiratory Care: 67 (6)
Respiratory Care
Vol. 67, Issue 6
1 Jun 2022
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Postextubation Stridor in Severe COVID-19
Georges Abi Abdallah, Alexis Ferré, Antoine Gros, Christelle Simon, Fabrice Bruneel, Stéphanie Marque-Juillet, Stéphane Legriel, Marine Paul
Respiratory Care Jun 2022, 67 (6) 638-646; DOI: 10.4187/respcare.09527

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Postextubation Stridor in Severe COVID-19
Georges Abi Abdallah, Alexis Ferré, Antoine Gros, Christelle Simon, Fabrice Bruneel, Stéphanie Marque-Juillet, Stéphane Legriel, Marine Paul
Respiratory Care Jun 2022, 67 (6) 638-646; DOI: 10.4187/respcare.09527
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Keywords

  • postextubation laryngeal edema
  • postextubation stridor
  • viral load
  • COVID-19
  • SARS-CoV-2

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